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https://hdl.handle.net/20.500.12452/3334

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Does the presence of arthroscopically detected stage 1-2 glenohumeral osteoarthritis have any clinical impact on the outcome of arthroscopic rotator cuff repairs?
(TÜBİTAK (Scientific and Technological Research Council of Türkiye), 2023) Tokgöz, Mehmet Ali; Elma, Tarık; Yapar, Aliekber; Özer, Mustafa; Ataoğlu, Muhammet Baybars; Kanatlı, Ulunay
Background/aim: Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis.Materials and methods: From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores.Results: The UCLA scores increased from the preoperative value of 19.1 +/- 3.2 to 29.8 +/- 4.8 at the last follow-up and increased by an average of 10.7 +/- 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 +/- 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001).Conclusion: To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate.
Radiological and clinical evaluation of long head of biceps tendon function in the glenohumeral
(Turkish Joint Diseases Foundation, 2023) Duman, Numan; Özer, Mustafa
Objectives: The aim of the study was to investigate the relationship between biceps pathologies and radiological measurements in massive rotator cuff tears treated arthroscopically. Patients and methods: Between December 2015 and December 2018, a total of 145 patients (56 males, 89 females; mean age: 62.2 +/- 9.7 years; range, 28 to 87 years) with supraspinatus and/or infraspinatus full-thickness tear larger than 3 cm and who underwent arthroscopic rotator cuff repair were retrospectively analyzed. Biceps pathologies detected during arthroscopy were divided into four groups. Group 1: biceps tendinitis or without biceps pathology; Group 2: biceps partial/degeneration tear; Group 3: biceps dislocation/instability; Group 4: complete biceps head rupture. Radiological measurements were calculated from the preoperative magnetic resonance imaging and anteroposterior X-ray images of the patients. Results: A total of 65.5% of the lesions were on the right arm and 34.5% were on the left arm. All patients had posterior superior rotator cuff tears which could be surgically repaired. A total of 22.1% of the patients had no biceps tendinitis/biceps pathology, 20.7% had biceps instability/dislocation, 28.3% had biceps degeneration/partial rupture, and 29% of patients had biceps total rupture. Patients in Group 4 had a statistically significantly higher superior migration of the humeral head distance (p= 0.012) than Group 2, and patients in Group 2 had a statistically significantly higher coracohumeral distance (p= 0.042) than patients in Group 4. There was no significant difference in the other measurements among the groups. Conclusion: The long head of the biceps, of which function has not yet been clearly elucidated, is one of the superior and anterior stabilizing forces of the humeral head.
Is lesser tuberosity morphology related to subscapularis tears and anterior shoulder instability?
(Springer, 2023) Yaka, Haluk; Özer, Mustafa; Kanatlı, Ulunay
Purpose: Although the morphological relationship of the scapula and the humeral head has been claimed to be related to shoulder pathologies, few studies examined the relationship between subscapularis (Ssc) tears and lesser tuberosity (LT)— humeral head (HH) and between Ssc tears and HH—glenoid. This study aims to evaluate the relationship of LT with HH and glenoid in patients with Ssc tears and anterior shoulder instability (ASI). We hypothesized that the glenoid, HH, and their combined relationship with LT may impact Ssc tears and ASI. Material and methods: The study included 34 patients with ASI, 28 patients with isolated Ssc tears, and 40 patients as the control group. The radius of HH (Hr), the distance between the center of HH and LT (LTr), and the glenoid radius (Gr) were measured in shoulder magnetic resonance (MR) images. The LTr to Hr (LTr/Hr) ratio was defned as the lesser tuberosity humeral head index (LTHHI), whereas the LTr to Gr (LTr/Gr) ratio was defned as the lesser tuberosity-glenoid index (LTGI). The three groups were compared regarding LTHHI, LTGI, LTr, Hr, and Gr. Results: There was a signifcant diference between each group concerning LTGI (p<0.001). LTGI values below 1.99 showed 93.1% sensitivity and 93.3% specifcity for Ssc tears, while values above 2.24 showed 86.7% sensitivity and 86.2% specifc ity for ASI. Also, there was a signifcant diference when the groups were compared for LTHHI (p<0.001). This rate was lowest for Ssc tears, and LTHHI values below 1.17 showed 82.8% sensitivity and 80.1% specifcity. Conclusion: LTGI may be a new predictive factor showing 93.1% sensitivity and 93.3% specifcity for Ssc tears and 86.7% sensitivity and 86.2% specifcity for ASI. In addition, LTHHI may be a new predictive factor showing 82.8% sensitivity and 80.1% specifcity for Ssc tears. Level of evidence: III retrospective comparative study.
Eş zamanlı bilateral tuberositas tibia avulsiyonu: Nadir bir kırık
(2013) Metineren, Hasan; Güleç, Ali; Serdar, Toker; Yel, Mustafa; Kaçıra, Burkay Kutluhan
Tuberositas 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.
The Evaluation of Two Different Surgical Approaches in Total Hip Arthroplasty According to the Patient Satisfaction, Plantar Pressure Distribution and Trendelenburg Sign
(2019) Yildirim, Ahmet; Ayanaoğlu, Tacettin; Mustafa , Özer; Esen, Erdinç; Kanatli, Ulunay; Bölükbaşi, Selçuk
The aim of this prospective study was to analyze the results of two different surgical aproaches for total hip arthroplasty as Trendelenburg sign, plantar pressure distribution with the help of dynamic pedobarography and clinical results by Harris Hip Score. A total of 28 patients who underwent unilateral total hip arthroplasty using two different types of lateral approach as conventional lateral Hardinge approach and intermuscular Hardinge approach described by Pai were included in this study. Plantar pressures have maesured by EMED-SF pedobarography device and analysed by the help of a commercial software; that seperates the foot to the four different parts which are called masks. Trendelenburg’s sign has been estimated as grade 1 and grade 2 by the method which was described by Hardcastle and Nade. Clinical outcome was measured by comparing Harris Hip Scores pre-operatively and postoperatively at last clinic visit. In both groups after the two years from the surgery; total contact time has increased at the operation side when the results were compared before the surgery at the same side and at the other side after the surgery. Also when we looked at the first and second masks which show the significant part of the stance phase; contact areas have similarly increased and the changes at the peak pressures were similar as contact areas. In both groups Harris Hip score was increased significantly after the operation. This is the first study to compare two different lateral approaches by pedobarographic analysis, clinical evaluation and functional scoring. The fuctional and clinical early results are similar in both lateral hip approaches for total hip arthroplasty when superior gluteal nerve protection, conjuant tendon repair and postoperative rehabilitation have done well.
Is routine coracoplasty necessary in isolated subscapularis tears?
(2019) Ayanaoğlu, Tacettin; Ataoğlu, Baybars; Özer, Mustafa; Çetinkaya, Mehmet; Kaptan, Ahmet Yiğit; Kanatlı, Ulunay
Objectives: This study aims to investigate the effect of simultaneous coracoplasty on postoperative clinical outcomes of patients undergoing shoulder arthroscopy due to the tear of the isolated subscapularis. Patients and methods: The study included 53 patients (16 males, 37 females; mean age 55.8 years; range, 44 to 70 years) who underwent arthroscopic repair for isolated subscapularis tear (type 2 and type 3) with anterior shoulder pain and tenderness. All patients had a coracohumeral distance of less than 7 mm on the preoperative magnetic resonance images and a minimum follow-up period of two years. Patients were divided into two groups as group 1 including patients who underwent coracoplasty and group 2 including those who did not undergo coracoplasty. Patients were evaluated pre- and postoperatively by the University of California Los Angeles (UCLA) shoulder score and the simple shoulder test (SST) score. Results: There were no significant differences between the groups in terms of age, gender and follow-up time (p0.05). The preoperative mean UCLA score was 19.65 for group 1 and 20.45 for group 2. The postoperative mean UCLA scores were 27.92 and 29.00, respectively. The preoperative mean SST score was 4.9 for group 1 and 5.1 for group 2. The postoperative mean SST scores were 10.0 and 9.5, respectively. Functional scores increased significantly in both groups postoperatively when compared to the preoperative values (p0.01). However, there was no statistically significant difference in terms of the increase in UCLA and SST scores between the two groups (p0.05). Conclusion: We believe that concomitant coracoplasty during arthroscopic repair may not be a necessary routine in the treatment of isolated subscapularis tears.
Do intra-articular pathologies accompanying symptomatic acromioclavicular joint degeneration vary across age groups?
(2019) Özer, Mustafa; Ataoğlu, Muhammet Baybars; Çetinkaya, Mehmet; Ayanoğlu, Tacettin; Kaptan, Ahmet Yiğit; Kanatlı, Ulunay
Objectives: This study aims to evaluate the accompanying intraarticular pathologies in patients who underwent arthroscopic distal clavicle resection (DCR) for symptomatic acromioclavicular (AC) joint degeneration based on age groups and to reveal which additional pathologies should be considered across different age groups during physical examination of patients suspected of AC joint degeneration. Patients and methods: The study included 156 patients (55 males, 101 females; mean age 57.210.0 years; range, 35 to 80 years) who underwent arthroscopic DCR between January 2006 and December 2017 and had at least one clinical positive test for AC joint degeneration during the preoperative physical examination. The patients were divided into three groups as those aged 50 years (group 1), between 50-65 years (group 2), and 65 years (group 3). The concomitant intra-articular pathologies were evaluated across different age groups and compared between the groups. Results: Concomitant intra-articular pathologies were detected in 117 of a total of 156 patients. Additional pathology rate increased with increasing age (p0.002). More than one concomitant intraarticular pathologies were detected in 37 patients (23.7%). This rate increased with increasing age (p0.002). The number of patients with superior labrum anterior posterior (SLAP) lesion as the only additional pathology was 33 . This rate decreased with increasing age (p0.015). In group 1, the rate of concomitant SLAP lesion was 44.1%. Conclusion: The high incidence of intra-articular pathologies accompanying symptomatic AC joint degeneration raises the importance of careful physical examination, detailed imaging, and arthroscopic surgery to obtain good results in patients scheduled for DCR. The frequency of AC joint degeneration and concomitant SLAP lesions, particularly in younger patients, should be considered during clinical examinations.
Hip arthroscopy for Legg-Calve-Perthes disease in paediatric population
(2019) Kanatlı, Ulunay; Ayanoğlu, Tacettin; Özer, Mustafa; Ataoğlu, Muhammet Baybars; Çetinkaya, Mehmet
Objective: The aim of this study was to represent the ?ndings and long-term clinical results of the children who underwent hip arthroscopy because of Legg-Calve-Perthes Disease (LCPD). Methods: This study included the retrospective ?ndings of ten patients (mean age: 12.7 2.75; range 7 e16 years) who underwent arthroscopic hip debridement between 2010 and 2016 for LCPD disease. All of the patients underwent arthroscopic excision of the unstable osteochondral fragment following unsuccessful conservative treatment. In the statistical analysis, age, side, follow-up, Stulberg and Waldenstrom classi?cation, preoperative and postoperative modi?ed Harris Hip Score (mHHS) were evaluated. Results: The mean follow-up period was 55.4 13.05 months (range: 40e72 months). There was no statistically signi?cant association between good postoperative results and age, side, and the stage of the disease (p 0.05). However, there was a signi?cant difference between preoperative and postoperative mHHS (p 0.005). Conclusion: This study demonstrates an increase in the functional results and life quality of the patients who underwent hip arthroscopy due to LCPD. It is thought that hip arthroscopy, a minimally invasive procedure, may have an important role in the algorithm of LCPD treatment, especially in patients with severe pain and mechanical symptoms.
Distribution and evaluation of bone and soft tissue tumors operated in a tertiary care center
(2019) Öztürk, Recep; Arıkan, Şefik Murat; Bulut, Emin Kürşat; Kekeç, Ahmet Fevzi; Çelebi, Fener; Güngör, Bedii Şafak
Objective: The aim of this study was to retrospectively evaluate the patients who were operated in our orthopedics and traumatology clinic with the suspection of bone and soft tissue tumors. Methods: A total of 3133 patients (1146 female and 1318 male) who presented to our tertiary clinic from different regions of Turkey between January 2002 and July 2013 with the presumed diagnosis of bone and soft tissue tumors were analyzed according to age, gender, bone/soft tissue localization, tumoral localization, histopathological diagnosis, tumor size and incidence. Results: Of all operatedpatients, 2464 were diagnosed with tumor, while non-tumoral causes were found in 669 patients. Of the cases diagnosed with tumor, 1139 were bone localized, 1004 soft tissue localized, and 321 metastasis. The most common benign bone tumors were osteochondroma (130), enchondroma (96), and simple bone cysts (90), while the most common malignant bone tumors were osteosarcoma (241), ewing's sarcoma (89), and chondrosarcoma (77); respectively. The most common benign soft tissue tumors were lipoma (141), giant cell tumors (108) and ganglion (107), while the most common malignant soft tissue tumors were liposarcoma (55), synovial sarcoma (53) and malignant mesenchymal tumors (45); respectively. Conclusion: Musculoskeletal tumors are rare, but descriptive data in any region are important in order to reduce mortality and improve treatment. No signicant difference was found between the data of our hospital regarding epidemiology of the musculoskeletal system tumors and those from the other regions around the world.
Which Operations of Musculoskeletal Tumors Should Be Accompanied by a Vascular Surgeon?
(2018) Yıldırım, Ahmet; Öztürk, Recep; Arıkan, Şefik Murat; Kekeç, Ahmet Fevzi; Günaydın, İlknur Bahar
INTRODUCTION: Benign and malign tumors of the musculoskeletal system may be related with thecriticalneurovascular structures. Therefore, some surgical procedures are applied with cardiovascular surgeons. In thisstudy, demographic examination of the musculoskeletal tumors which might be related with neurovascularstructures was aimed.METHODS: Between 2010 and 2014, 58 patients who were operated with cardiovascular surgeon due tomusculoskeletal tumors in orthopedics and traumatology clinic were included in the study. Patients were examinedfor age, sex, benign / malignant features, bone-soft tissue location, histopathological diagnosis and tumorlocalization.RESULTS: Among 30 male and 28 female patients with a mean age of 36 0,17 (2-76 years), 15 patients hadbenign and 43 patients had malign musculoskeletal tumors. The most common tumor was a malign mesenchymaltumor and it was seen in 14 cases. The most common benign tumor was osteochondroma and it was found in 6cases. The most common tumor localization with cardiovascular surgeon requirement was thigh and knee.DISCUSSION and CONCLUSION: Musculoskeletal tumors may be closely related to the neurovascularstructures and therefore they are needed to beoperated with cardiovascular surgeons; can be seen in kind of ages.These are often malign tumors. The most common localizations are thigh and knee.
Unusual Presentation of Bilaterally Symmetrical Gout Tophi on Elbows
(2018) Kekeç, Ahmet Fevzi; Bozgeyik, Bilgin; Yılmaz, Selçuk
Gout is a crystal deposition rheumatic disease. It is a more common inflammatory arthritis in men, characterized by formation ofmonosodium urate crystals in the synovial fluid of joints and in other tissues. It commonly deposits in the feet, ankles, knees, hands,wrists, and elbows. A 54-year-old male presented with big symmetrical masses developed gradually on both the elbows over thelast 4 years. Radiographs of both the elbows showed soft tissue swellings with no involvement of bones. Masses were of intermediatesignal intensity on T1-weighted magnetic resonance images and high signal intensity on T2-weighted images. Fine needleaspiration cytology was performed in masses on both the elbows. Light microscopy of the Giemsa- and Papanicolaou-stainedsmears demonstrated abundant granular amorphous material and scattered stacks of slender needle-shaped crystals, associatedwith chronic inflammatory infiltrate. Based on the above findings, a diagnosis of gout tophi was made. After informed consentwith the patient under general anesthesia, marginal resection of tophi were performed in the same session with clear margins. Wedescribe the treatment of a patient with long-standing chronic gout tophus located bilaterally at the elbow joint complicated bybursal deposit with rapid progression during the last 4 years. To the best of our knowledge, our case presentation may be the firstcase report where huge tophi were symmetrical and bilaterally presented on both the elbows.
Multiple cervical spinous process fracture (clay shoveler fracture): Case report
(2017) Ayanoğlu, Tacettin; Ataoğlu, Muhammet Baybars; Özer, Mustafa; Yıldırım, Ahmet; Tokgöz, Mehmet Ali
Clay-Shoveler’s is fracture of one or more spinous processes to include lower cervical or upper thoracic vertebrae. In this article, it was aimed to investigate possible mechanisms of Clay-Shoveler’s fracture and share radiological results of q case of 11 years (2003) follow-up after the traffic accident. A 25-year-old male patient complained of neck pain spreading to both shoulders, andthere was an in-car traffic accident two weeks ago. Patient’s motion restriction was 50% for active flexion, lateral flexion and rotation, and 20% for active extension movement. Imaging revealed a minimal inferior displaced avulsion fracture in C6, C7 and T1 vertebra spinous processes. Patient returned to daily activities in 3rd month after immobilization with medical treatment and neck collar.Clay-Shoveler’s fracture is most commonly seen in T1, then C7, T2, T3 and C6. Surgical treatment is not planned because patient has no limitation of neck movements and neck pain which responds to medical treatment.
Girişimsel İşlemler İçin Sakral Kanal ve Hiatusun Çok Kesitli Bilgisayarlı Tomografi ile Morfometrik Analizi
(2015) Kılıçaslan, Alper; Keskin, Fatih; Babaoğlu, Ozan; Gök, Funda; Erdi, Mehmet Fatih; Kaya, Bülent; Özbiner, Hüseyin; Özbek, Orhan; Koç, Osman; Kaçıra, Burkay Kutluhan
AmAÇ: Yakın zamanda sakral kanal, omurga hastalıklarının minimal invaziv tanı ve tedavi işlemleri için "bir koridor olarak" sıkça kullanılmaya başlanmıştır. Çalışmanın amacı sakral kanalın, hiatusun ve çevre yapıların farklı yaş gurupları ve cinsiyete göre morfometrik analizlerinin çok kesitli bilgisayarlı tomografi yöntemiyle incelenmesidir. yÖNTem ve GeReÇLeR: Üç farklı yaş grubuna (20-80 yaş arasında) ayrılan 300 yetişkin (150 kadın ve 150 erkek; 20-80 yaş) hastanın multiplanar rekonstrüksiyon görüntüleri kaydedildi ve geriye dönük olarak incelendi. Sakral hiatus ve çevre yapılar ile sakral kanala ait çeşitli anatomik ölçümler yapıldı. Sakral kurvatür açısı ve lumbosakral lordotik açı kaydedildi. BuLGuLAR: Bazı olgularda hiatus yokluğu (%0,3), komplet agenezis (%1) ve kemik septum (%2,6) gibi kemik anomalilerine rastlandı. Anteroposterior (AP) Hiatus çapı olguların %5'sinde 2 mm nin altındaydı. Tüm yaş gruplarında, hiatus AP çapı ve hiatus alan ve "sakral kanal AP çapının en kısa mesafesinin" ortalaması, 60-80 yaş grubunda, 20-40 yaş grubuna göre daha kısaydı (p0,01). Sakral kanal AP çapın en küçük olduğu lokalizasyon, en çok olguların %59,2'unda S2 ve %33,9'unda S3 seviyesinde idi. Maksimum kurvatür seviyesi olguların %63,3'ün de S3 ve %26,7'sin de S2 seviyesinde idi. Sakral kürvatur açı ve lumbosakral lordotik açı sırayla 164 and 134 olarak ölçüldü. soNuÇ: Sakral yapılarda anatomik varyasyonlar sık görünür. Anatominin ayrıntılı analizi, girişimsel işlemlerin başarısını ve güvenilirliğini artırabilir.
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 Ali
AMAÇ: 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.
Results of surgical treatments in mallet finger deformity
(2012) Güleç, Ali; Kütahya, Harun; Kaçıra, Kutluhan Burkay; Bilge, Onur; Toker, Serdar; Yel, Mustafa
Introduction: 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.
Hydatid cyst of sacrum affecting the sakroiliac joint: A case report
(2013) Güzel, Yunus; Kaçıra, Burkay Kutluhan; Göncü, Recep; Güleç, Ali; Kütahya, Harun; Yel, Musfata
Amaç: Ciddi ve ilerleyici bel ağrısına neden olan ve yanlış tanı almış nadir görülen bir kist hidatik vakasını tanımlamak. Giriş: Hidatik hastalık ya da hidatidozis dünyada yaygın bir insan sestod enfeksiyonudur ve karakteristik coğrafi k bir dağılıma sahiptir. Karaciğer ve akciğerler en sık tutulur. Vakalarda kemik tutulumu %4den daha azdır. Vertebral hidatik hastalık nadirdir. Sakroiliak eklem bulguları ve bel ağrısı ayırıcı tanıyı zorlaştırır ve bu nadir durum yanlış tanıya neden olabilir. Olgu Sunumu: Sakrum ve pelvisin sekonder hidatit kistlerinin kalça ağrısına neden olduğu 21 yaşında bayan hasta sunuldu. Başka bir merkezde sakroileit ve siyatik ağrısı tanısı almış ve tedavisi başarısız olan hasta kliniğimize sevk edildi. Fizik muayenesi ve radyolojik testleri sol sakrumdan başlayıp sakroiliak kemiğe uzanan iliak kemik lezyonlarını açığa çıkardı. Sonuç: Medikal tedaviyi takiben, küretaj ve greftleme uygulandı. Lezyondan çıkarılan materyalin makroskopik görünümü ve histopatolojik değerlendirilmesi hidatit hastalık ile uyumluydu. 11 aylık takibinde nüks gözlenmedi ve hasta semptomsuzdu. Tartışma: Erken dönemlerinde kemik hidatik hastalığı yanlış tanı alabilir. Hastalık ilerler ve kemiği destrükte eder. Hidatitk hastalık öyküsü olan ve kas-iskelet şikâyetleri olan hastalarda hidatik kist hastalığı ihtimali akılda tutulmalıdır. Debride edilen vertebrada kalan kavitenin kemik greftiyle doldurulmasının daha güvenilir olduğuna inanıyoruz.
Omuz iç rotasyonunun korakohumeral ve akromiyo aralığa etkisinin üç boyutlu tomografi ile değerlendirilmesi
(2018) Özer, Mustafa; Çetinkaya, Mehmet; Koçkara, Nizamettin; Ataoğlu, Muhammet Baybars; Genç, Erdinç; Kanatlı, Ulunay
Amaç: Bu çalışmanın amacı korakohumeral aralık ve akromiyohumeral aralık miktarının omzun pasif iç rotasyonu ile gerçekten azalıp azalmadığını değerlendirmekti. Gereç ve Yöntem: Çalışmada Mayıs 2016 ile Ekim 2016 arasında poliklinikte rotator kılıf hasarı ön tanısı ile bilgisayarlı tomografi artrografi çekilen hastalar kullanıldı. Bilgisayarlı tomografi artrografi tetkiki omuz nötral ve iç rotasyonda olmak üzere iki kez yapıldı ve görüntülerin 3 boyutlu rekonstrüksiyonları oluşturuldu. Bu iki bilgisayarlı tomografi tetkikinin 3 boyutlu bilgisayarlı tomografi görüntülerinde korakohumeral aralık ve akromiyohumeral aralık ölçümleri yapıldı. Bulgular: Çalışmaya yaş ortalamaları 64.069.06 olan 17 hasta dahil edildi. Tam kat supraspinatus yırtığı olanlarla olmayanlar değerlendirildiğinde, korakohumeral aralık ve akromiyohumeral aralığın omzun nötral ve iç rotasyonundaki ölçümlerinin ortalamaları arasında istatistiksel olarak anlamlı fark görülmedi. Kadın ve erkekler arasında ölçüm ortalaması arasında istatistiksel fark yoktu. Sonuç: Omzun pasif iç rotasyonu ile korakohumeral aralık anlamlı derecede daralmaktadır. Üç boyutlu bilgisayarlı tomografi ile yapılan ölçümler korakoid anatomisi ve korakoidin çeşitli parametreleri ile ilgili bize daha güvenilir bilgi verebilirler.
Korakoid taşma ile subskapularis yırtıkların ilişkisi
(2018) Çetinkaya, Mehmet; Ataoğlu, Muhammet Baybars; Özer, Mustafa; Ayanoğlu, Tacettin; Kaptan, Ahmet Yiğit; Kanatlı, Ulunay
Amaç: Bu çalışmanın amacı izole subskapularis yırtıklarında etiyolojik bir faktör olan subkorakoid sıkışmada korakoid taşmanın bir risk faktörü olarak geçerliliğini araştırmaktır.Gereç ve Yöntem: Omuz artroskopisi uygulanan hastalardan izole subskapularis ve izole tam kat supraspinatus yırtıklı hastalar randomize olarak seçilerek iki grup oluşturuldu. Manyetik rezonans görüntüleme ve ameliyat videoları retrospektif olarak tekrar incelenerek T1 aksiyel manyetik rezonans görüntüleme kesitlerinde korakoid taşma miktarı ve korakoid taşma/humerus başı çapı oranı hesaplandı ve ortalamaları karşılaştırıldı.Bulgular: Çalışmada her iki grupta 28’er hasta olmak üzere toplam 56 hasta vardı. Hastaların yaş ortalamaları Grup 1 ve 2’de sırasıyla 48.719.66 ve 64.856.1 olarak bulundu. Cinsiyet ve ameliyat olan taraf bakımından fark yoktu. Ortalama korakoid taşma değerleri Grup 1 ve 2’de sırasıyla 16.085.6 ve 14.655.92, korakoid taşma/humerus başı çapı oranı ise 0.330.11 ve 0.290.11 bulundu. Ortalama korakoid taşma ve korakoid taşma/humerus başı çapı değerleri bakımından iki grup arasında anlamlı fark saptanmadı.Sonuç: Korakoid taşma ile subkorakoid sıkışma arasında istatistiksel olarak gerçek anlamda bir ilişki yoktur. Subskapularis yırtıklarında varlığı hala tartışmalı olan subkorakoid sıkışmaya bu çalışma ile de kanıt bulunamamıştır.
Pediatrik Hastalarda Femur Diafiz Kırıklarının Elastik Titanyum Çiviler ile Tedavisi
(2016) Bilge, Onur; Güzel, Yunus; Güvenç, Kenan; Toker, Serdar; Yel, Mustafa
Amaç: 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.
Tetik parmak tedavisinde steroid enjeksiyonu mu? Açık cerrahi mi?
(2017) Acar, Erdinç
Amaç: Açık cerrahi ve steroid enjeksiyonu uygulanan tetik parmak hastaları arasında fark olup olmadığını değerlendirdik. Gereç ve Yöntem: Kasım/2012 ile Mayıs/2015 tarihleri arasında başvuran 108 hastanın (64 bayan, 44 erkek) el baş parmağına bir gruba (34 bayan, 20 erkek) açık cerrahi uygulandı. Diğer gruba (30 bayan, 24 erkek) steroid enjeksiyonu uygulandı. Bu hastalar Wolfe sınıflamasına göre değerlendirildi. Bu hastalarda yineleme oranı ve memnuniyet oranları değerlendirildi. Cerrahi yapılan hastalarda yara yeri enfeksiyonu, sinir hasarı, yarada açılma, fleksör tendonda ok-yayı deformitesi, eklem hareket açıklığında kısıtlanma komplikasyonları değerlendirilmiştir. Bulgular: Hastaların yaş ortalaması 38,2. Wolfe sınıflamasına göre 46 (%42,5) olgu evre 2,62 (%57,5) olgu evre 3 idi.Hastaların 64'ü (%59,2) bayan,44'ü (%40,8) erkek idi. Hastalar ortalama 12 ay takip edildi. Steroid enjeksiyonu uygulanan grupta 20 (%37) hastada yineleme görüldü. Yineleme görülen hastalara açık cerrahi uygulandı. Açık cerrahi uygulanan grupta yineleme izlenmedi. Cerrahi uygulanan hastaların tamamı tedaviden memnun kaldıklarını belirtti. Sonuç: Steroid enjeksiyonu tetik parmak tedavisinde bir tedavi seçeneği olmasına rağmen, açık cerrahi uygulanan hastaların nüks ve komplikasyon gelişmemesi açısından daha yararlı bir yöntem olduğu görüldü.

Güncel Gönderiler