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Gültaç E, Kılınç B, Kılınç CY, Yücens M, Aydogan NH, Öznur A. Comparison of tunnel ligament release instrument assisted minimally open surgery and conventional open surgery in the treatment of tarsal tunnel syndrome. J Orthop Surg (Hong Kong) 2021; 28:2309499020971868. [PMID: 33215572 DOI: 10.1177/2309499020971868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIM This study compared the results of tarsal tunnel syndrome release surgeries using mini-open incisions and standard incisions. PATIENTS AND METHODS From January 2012 until April 2018, 31 feet of 29 patients diagnosed with tarsal tunnel syndrome were treated surgically. 15 feet of 15 patients underwent surgeries utilizing minimally open technique and 16 feet of 14 patients underwent surgeries utilizing standard incisions. The following preoperative and postoperative data was obtained: foot and ankle muscle testing results, posture analyses, anthropometric measurements, joint movement ranges, pain complaints, endurance evaluation results, and functional test results. The mean follow-up period was 38 months (13-88 months). RESULTS The mean operation times were 26.8 min (23-30 min) using the standard incision and 13.3 min (9-17 min) using the mini-open incision (p < 0.05). In the preoperative and postoperative comparisons of the total muscle strength and total joint limit values of the healthy and affected feet, statistically significant improvements were observed in both the mini-open incision and standard incision groups (p < 0.05). Moreover, statistically significant improvements were seen in both groups in the postoperative repeated toe raises for 1 minute assessments of the affected foot (p < 0.05). In the foot function index and functional foot score values, statistically significant improvements were seen between the preoperative and postoperative values in both groups (p < 0.05). CONCLUSIONS Based on the results of this study, using a tunnel ligament release instrument assisted minimally open surgery to loosen the laciniate ligament may present an alternative to the standard incision, with its significantly decreased morbidity rate and cosmetic success.
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Affiliation(s)
- Emre Gültaç
- Department of Orthopedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Barış Kılınç
- Department of Orthopedics and Traumatology, Private 19 May Hospital, Ankara, Turkey
| | - Cem Yalın Kılınç
- Department of Orthopedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Mehmet Yücens
- Department of Orthopedics and Traumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Nevres Hurriyet Aydogan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Ali Öznur
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kastamonu University, Kastamonu, Turkey
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Tanoğlu O, Say F, Yücens M, Alemdaroğlu KB, İltar S, Aydoğan NH. Titanium Alloy Intramedullary Nails and Plates Affect Serum Metal Ion Levels within the Fracture Healing Period. Biol Trace Elem Res 2020; 196:60-65. [PMID: 31621008 DOI: 10.1007/s12011-019-01913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 11/28/2022]
Abstract
Titanium alloy implants are the most used materials for the fixation of lower extremity fractures. Although these implants were thought to be inert materials in vitro, several studies have shown increased serum and remote tissue metal ion levels due to wear of implants and friction of the bone-implant interface in vivo. The aim of this study was to investigate the alteration of serum metal ion levels that are released from intramedullary nails and plates used for the fixation of lower extremity fractures, within the fracture healing period. The study included 20 adult patients, who were treated with intramedullary nail or plate osteosynthesis due to closed lower extremity fractures. Alterations of serum titanium, aluminum, molybdenum, and vanadium levels were evaluated at 6, 12, 18, and 24 weeks postoperatively. A statistically significant increase was determined in serum titanium, aluminum, molybdenum, and vanadium ion levels in the intramedullary nail and plate groups at the end of the follow-up period. Pairwise comparisons of metal ion levels between implant groups revealed no significant difference during a 24-week follow-up period. Compared to the control group, statistically significant increased levels of serum titanium, aluminum, vanadium, and molybdenum ions were determined in the implant groups used for the fixation of lower extremity fractures at the end of 24 weeks. In the current literature, the potential toxic effects of prolonged exposure to low levels of these metal ions are still unknown. It can be predicted that long-term metal ion exposure could result in vivo pathological processes in the future.
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Affiliation(s)
- Oğuzhan Tanoğlu
- Faculty of Medicine, Department of Orthopedics and Traumatology, Erzincan Binali Yıldırım University, Erzincan, Turkey.
| | - Ferhat Say
- Faculty of Medicine, Department of Orthopedics and Traumatology, Ondokuz Mayıs University, Samsun, Turkey
| | - Mehmet Yücens
- Faculty of Medicine, Department of Orthopedics and Traumatology, Pamukkale University, Denizli, Turkey
| | - Kadir Bahadır Alemdaroğlu
- Department of Orthopedics and Traumatology, SBU Ankara Research and Training Hospital, Ankara, Turkey
| | - Serkan İltar
- Department of Orthopedics and Traumatology, SBU Ankara Research and Training Hospital, Ankara, Turkey
| | - Nevres Hürriyet Aydoğan
- Faculty of Medicine, Department of Orthopedics and Traumatology, Muğla Sıtkı Koçman University, Muğla, Turkey
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Alemdaroğlu KB, İltar S, Ozturk A, Gültaç E, Yücens M, Aydoğan NH. The Role of Biplanar Distal Locking in Intramedullary Nailing of Tibial Shaft Fractures. Arch Bone Jt Surg 2019; 7:33-37. [PMID: 30805413 PMCID: PMC6372272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 11/11/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND To compare the union times of the uncomplicated tibial shaft fractures, which were distally locked by two coronal and one sagittal screws and by only two coronal screws. METHODS 45 patients with tibial shaft treated with intramedullary nailing included in this study. 23 of 45 fractures were treated with uniplanar two distal interlocking (Group 1) and 22 fractures were treated with biplanar three distal interlocking (Group 2). Patients with closed fractures treated by closed nailing and having a full set of radiographs on PACS system was included. Fracture unions were evaluated by two authors. RESULTS Union time was significantly shorter in biplanar distal interlocking group (Group 2) compared to uniplanar distal interlocking group (Group 1) (P=0.02). Mean union time in groups 1 and 2 were 14.63±4.5 and 10.77±3.0 weeks, respectively .When only distal third tibial shaft fractures were evaluated, Group 2 [11.2±3.1 weeks (n:17)] had significantly lower union time compared to Group 1 [15.07±4.8 weeks (n:14)] (P=0.01). Inter-observer reliability for fracture union times was high with rho= 0.89 with SE of 0.51 (P<0.001). CONCLUSION Biplanar distal interlocking procedure had a significantly shorter union time. Biplanar distal interlocking procedure allows a faster fracture union probably because of a more stable fixation construct.
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Affiliation(s)
- Kadir Bahadır Alemdaroğlu
- Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Faculty of Medicine, Pamukkale University, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Research performed at University of Health Sciences; Ankara Training and Research Hospital, Turkey
| | - Serkan İltar
- Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Faculty of Medicine, Pamukkale University, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Research performed at University of Health Sciences; Ankara Training and Research Hospital, Turkey
| | - Alper Ozturk
- Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Faculty of Medicine, Pamukkale University, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Research performed at University of Health Sciences; Ankara Training and Research Hospital, Turkey
| | - Emre Gültaç
- Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Faculty of Medicine, Pamukkale University, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Research performed at University of Health Sciences; Ankara Training and Research Hospital, Turkey
| | - Mehmet Yücens
- Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Faculty of Medicine, Pamukkale University, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Research performed at University of Health Sciences; Ankara Training and Research Hospital, Turkey
| | - Nevres Hürriyet Aydoğan
- Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Faculty of Medicine, Pamukkale University, Ankara, Turkey
- Faculty of Medicine, Muğla Sıtkı Koçman University, Ankara, Turkey
- Research performed at University of Health Sciences; Ankara Training and Research Hospital, Turkey
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Firat A, Alemdaroğlu KB, Özmeriç A, Yücens M, Göksülük D. Morphometric study of the true S1 and S2 of the normal and dysmorphic sacralized sacra. Turk J Med Sci 2017; 47:954-959. [PMID: 28618750 DOI: 10.3906/sag-1505-84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 12/26/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM This study aimed to generate data for the S1 and S2 alar pedicle and body and the alar orientations for both dysmorphic and normal sacra. MATERIALS AND METHODS The study comprised two groups: Group N consisted of 53 normal sacra and Group D included 10 dysmorphic sacra. Various features such as alar pedicle circumference; anterior, middle, and posterior axis of the sacral ala; sacral body height and width; and sagittal thickness were measured. RESULTS In group N, the median anterior axis of the alae was observed to be 30° on the right and 25° on the left, the median midline axis was found to be 20° on the right and 15° on the left, and the median posterior alar axis was -15° on the right and -20° on the left. The true S1 and S2 alar pedicle circumferences were observed to be significantly smaller in group D, which demonstrated a shorter S1 alar pedicle mean circumference, significantly narrower S1 body mean width, and considerably tapered sagittal thickness. CONCLUSION Our analysis indicated that dysmorphic sacra have a lower sagittal thickness and width of bodies and smaller alar pedicles, which explains the difficulties in their percutaneous fixation.
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Affiliation(s)
- Ayşegül Firat
- Department of Anatomy, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Ahmet Özmeriç
- Department of Orthopedics, Ankara Training and Research Hospital, Ankara, Turkey
| | - Mehmet Yücens
- Department of Orthopedics, Ankara Training and Research Hospital, Ankara, Turkey
| | - Dinçer Göksülük
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Alemdaroğlu KB, Yücens M, Kara T, Gül D, Aydoğan NH. Pedicle axis view combined by sacral mapping can decrease fluoroscopic shot count in percutaneous iliosacral screw placement. Injury 2014; 45:1921-7. [PMID: 25457343 DOI: 10.1016/j.injury.2014.10.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/23/2014] [Accepted: 10/14/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Percutaneous iliosacral screw fixation of the posterior pelvic ring is a demanding procedure with high exposure to radiation. The conventional technique includes the use of three classical projections with the C-arm: inlet, outlet, and true lateral views. A projection in the axis of the upper sacral alar pedicles with a 30° cephalad and 30° ventral oblique view would help in obtaining a more accurate visualization of the safe corridor. Two subcutaneously placed K-wires, one placed horizontally and one vertically, may facilitate the starting point and aim changes by offering the surgeon an option for exactly matching the position of the sacrum with the image. The purpose of this study was to detect if the radiation application could be decreased by our new methodology. METHODS Seventeen patients with pelvic posterior ring disruptions, in which percutaneous iliosacral screw placement was indicated, were included in the study. Group 1 comprised 7 patients in whom conventional projections and technique were used. Group 2 comprised 10 patients in whom 30°–30° projection and sacral mapping technique via two subcutaneous K-wires were applied. Radiation exposure time, total fluoroscopic shot count, fluoroscopic shot count needed for only guide wire and screw placement, radiation dose, and complications were compared between the two groups. RESULTS The median number of fluoroscopic images for guide and screw placement was 132 (56–220) and 29.5 (19–83) in Groups 1 and 2, respectively, and the difference was statistically significant (p < 0.001). The median total fluoroscopic radiation time was 138 (68–234) and 52 (28–77) s in Groups 1 and 2, respectively, and the difference was significant (p < 0.001). Group 1 had a significantly higher median radiation dose than Group 2 [3020 (1502–6032) vs. 1192 (426–2359); (p = 0.001)]. CONCLUSIONS Iliosacral screw placement with the help of sacral mapping and a fourth view, “30°–30°”, helps the surgeon to markedly reduce the fluoroscopic shots, radiation time and dose during guide wire and screw placement. LEVEL OF EVIDENCE Therapeutic, Level II.
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