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Yüce A, Misir A, Yerli M, Bayraktar TO, Tekin AÇ, Dedeoğlu SS, İmren Y, Gürbüz H. Syndesmosis Injuries in Lateral Malleolar Fractures Accompanied by a Posterior Malleolar Fracture: A Nonfixed Posterior Fracture Fragment May Not Affect Postoperative Tibiofibular Joint Malreduction Rates. J Am Podiatr Med Assoc 2023; 113:21-105. [PMID: 38170588 DOI: 10.7547/21-105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND The fact that lateral malleolar fracture is accompanied by posterior malleolar fracture may adversely affect syndesmosis malreduction rates. We aimed to compare syndesmosis malreduction rates determined on postoperative radiographs between isolated lateral malleolar fractures and lateral malleolar fractures accompanied by posterior malleolar fractures. METHODS We retrospectively examined 128 operative patients: 73 with isolated lateral malleolar fractures (group L) and 55 with lateral + posterior malleolar fractures (group LP). In group LP, no patients received posterior fragment fixation. In both groups, indirect syndesmosis fixation was performed with a single screw after open reduction and internal fixation of the lateral malleolus. Patient age, sex, fracture side, fracture type (Lauge-Hansen and Danis-Weber classifications), Kellgren-Lawrence osteoarthritis classification, syndesmotic incongruency on postoperative radiographs, syndesmotic malreduction of postoperative fibula fracture, fracture union time, complication rates, accompanying injuries, and preoperative and postoperative radiographic syndesmotic measurements (tibiofibular overlap, tibiofibular clear space, medial clear space) were recorded, and the groups were compared. RESULTS Mean ± SD age was 44.32 ± 15.66 years in group L and 48.93 ± 14.03 years in group LP (P = .087). There were no significant differences in preoperative and postoperative tibiofibular distance, tibiofibular overlap, and medial clear space values between groups (P > .05). The prevalence of grade 2 fractures according to the Kellgren-Lawrence classification was significantly higher in group LP (P = .047). Postoperative syndesmosis malreduction was detected in 12 patients in group L and in nine in group LP (P = .991). CONCLUSIONS In lateral malleolar fractures accompanied by small-fragment posterolateral or avulsion-type posterior malleolar fractures, closed syndesmotic screw fixation does not cause syndesmosis malreduction.
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Affiliation(s)
- Ali Yüce
- *Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Abdulhamit Misir
- †Department of Orthopedic and Traumatology, Private Safa Hospital, Istanbul, Turkey
| | - Mustafa Yerli
- *Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Tahsin Olgun Bayraktar
- *Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Ali Çağrı Tekin
- *Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Süleyman Semih Dedeoğlu
- *Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Yunus İmren
- *Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Hakan Gürbüz
- *Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
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Saygılı MS, Tekin AÇ, Bayraktar MK, Kır MÇ, Ayaz MB, Kanyılmaz S. Evaluation and Management of Idiopathic Unilateral Foot Drop. J Am Podiatr Med Assoc 2023:1-20. [PMID: 37647296 DOI: 10.7547/22-080] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND In this study, our purpose is to evaluate patients who were followed by acute developing single-sided foot drop and improving with conservative management or spontaneously. METHODS Between 2019 and 2020, 10 patients were evaluated for a unilateral weakness of the lower extremity in the form of absent dorsiflexion at the ankle joint and were given a diagnosis of foot drop without any etiological cause. Patients were followed for a period of 18 months. All patients were evaluated for acute foot drop of the affected extremity by utilizing the following diagnostic modalities, EMG, MRI lumbar spine, MRI knee, peripheral MRI neurography and non-contrast brain MRI. Each patient was evaluated for a history of Covid-19 infection over the past year. Patients with any identified cause were excluded. RESULTS Initial evaluation of muscle strength in all patients revealed 0/5 by the MRC muscle testing grading scale. (1) In 2 patients, the muscle strength was 3/5 at the 6th month, and in the other 8 patients 4/5 at the 6th month. The muscle strength of all patients improved as 5/5 in 1 year. Six of the patients were dispensed an AFO device and nine patient's performed physical therapy. Evaluation of EMG results identified significant neuropathy at the level of the common peroneal at the fibular head in all patients. In comparison with peroneal nerve stimulation below and above the fibular head in the lateral popliteal fossa; 50% reduction in sensory amplitude, and motor conduction slowing of >10 m/s was present. Evaluation of knee MRI revealed, no masses, edema, or anatomical variations at the level of the fibular head. CONCLUSIONS In patients diagnosed with unilateral acute foot drop without an etiological cause, one should keep in mind that spontaneous resolution of this condition can occur within one year period.
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Affiliation(s)
- Mehmet Selçuk Saygılı
- *Department of Orthopedics and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Ali Çağrı Tekin
- *Department of Orthopedics and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Mehmet Kürşad Bayraktar
- *Department of Orthopedics and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Mustafa Çağlar Kır
- *Department of Orthopedics and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Mustafa Buğra Ayaz
- *Department of Orthopedics and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Selcen Kanyılmaz
- †Department of Physical Therapy and Rehabilitation, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
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Bayraktar MK, Tekin AÇ, Kir MÇ, Ayaz MB, Ocak O, Mihlayanlar FE. Nail breakage in patients with hypertrophic pseudoarthrosis after subtrochanteric femur fracture: treatment with exchanging nail and decortication. Acta Orthop Belg 2023; 89:59-64. [PMID: 37294986 DOI: 10.52628/89.1.10592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this study, we aimed to show the results of exchange nail and decortication in patients whose subtrochanteric femur fractures were treated with intramedullary nails and subsequently developed fracture nonunion and nail breakage com- plications. This study consisted of patients presenting with subtrochanteric femur fractures between January 2013 and April 2019 who underwent surgery and later experienced nail breakage due to hypertrophic nonunion. There were a total of 10 patients aged 26-62 years (Avg 40,30, SD: 9,989). Nine patients were smokers, and 1 patient had diabetes and hypertension. Three patients were admitted to the trauma center due to a car accident and 7 patients were admitted because of a fall. The infection parameters of all patients were normal. All patients had pathological movement complications and pain at the fracture site. Preoperatively, medulla diameter was measured with standard radiography in all patients. The diameters of the old nails applied to the patients ranged from 10 to 12 mm, and the diameters of the newly applied nails ranged from 14 to 16 mm. The fracture lines of all patients were opened to remove the broken nails, and decortication was performed. No additional autograft or allograft was applied to any patient. Union was achieved in all patients. We conclude that the use of larger diameter nails in conjunction with decortication will prevent nail breakage, improve healing and provide early union in patients with subtrochanteric femur fractures with hypertrophic pseudoarthrosis.
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Yüce A, Mısır A, Yerli M, Bayraktar TO, Tekin AÇ, Dedeoğlu SS, İmren Y, Gürbüz H. The Effect of Syndesmotic Screw Level on Postoperative Syndesmosis Malreduction. J Foot Ankle Surg 2022; 61:482-485. [PMID: 34656414 DOI: 10.1053/j.jfas.2021.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 01/12/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 02/03/2023]
Abstract
Tibiofibular injury repair of ankle fractures may result in over-compression when performed via a partially threaded screw depending on its placed level. We aimed to examine the relationship between the screw level relative to the tibiotalar joint and syndesmosis malreduction in postoperative radiographs of ankle fractures treated with partially threaded screws. We retrospectively analyzed 129 patients who underwent surgery due to lateral malleolar fractures between 2011 and 2019. We measured the distance between the screw and the tibiotalar joint and stratified the patients per their screw level as either trans-syndesmotic or suprasyndesmotic. According to Lauge-Hansen, 83 cases were supination-external rotation type (64.3%), and the remaining were pronation-external rotation type (35.7%) injuries. We found postoperative syndesmosis malreduction in 20 cases (15.5%). Eight (6.2%) cases had medial clear space mismatch. As the distance of the screw to the joint increased, postoperative medial clear space values increased (rho: 0.190, p = .031). The relationship between postoperative syndesmosis mismatch and the level of the syndesmotic screw was statistically significant (p = .044). In syndesmosis repair with a partially threaded screw, as the distance of the screw from the joint increases, the over-compression caused by the screw may cause an increase in postoperative syndesmotic malreduction rates.
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Affiliation(s)
- Ali Yüce
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Abdulhamit Mısır
- Department of Orthopedic and Traumatology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Mustafa Yerli
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey.
| | - Tahsin Olgun Bayraktar
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Ali Çağrı Tekin
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Süleyman Semih Dedeoğlu
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Yunus İmren
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Hakan Gürbüz
- Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
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Dedeoğlu SS, İmren Y, Çabuk H, Tekin AÇ, Kır MÇ, Gürbüz H. Arthroscopy-assisted versus standard intramedullary nail fixation in diaphyseal fractures of the humerus. J Orthop Surg (Hong Kong) 2018; 25:2309499017727949. [PMID: 28862100 DOI: 10.1177/2309499017727949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/17/2022] Open
Abstract
PURPOSE The aim of this study was to assess applicability of arthroscopic technique in intramedullary nail fixation of humerus shaft fractures and to compare with conventional nailing in terms of its effects on perioperative and postoperative intra-articular complication rates as well as on clinical and functional outcomes. METHODS This prospective randomized controlled clinical trial included 40 patients (12 females and 28 males) indicated for surgery between either undergo arthroscopy-assisted (Arthroscopy-assisted intramedullary nailing [AIMN]; n = 20) or conventional (Intramedullary nailing [IMN]; n = 20) anterograde intramedullary nailing. Two groups were compared in terms of mean number of fluoroscopic shootings until the guide wire was inserted, time for union, length of hospital stay, and complication rates. Shoulder functions were assessed by Constant and American Shoulder and Elbow Surgeons (ASES) score. RESULTS Groups did not significantly differ in terms of age, gender, and mechanism of injury, length of hospital stay, union rate, and mean union time ( p > 0.05). Mean ASES and Constant scores were found to be statistically significantly higher in AIMN group than that in IMN group ( p = 0.000 and p = 0.002, respectively). Mean number of fluoroscopic shootings until the guide wire was inserted was 2.15 in AIMN group, which was significantly lower compared to 4.2 of IMN group ( p = 0.000). CONCLUSIONS Arthroscopy-assisted technique may be an applicable and safe method owing to its cosmetic advantages and more satisfactory postoperative shoulder functions subsequent to less injury to deltoid, rotator cuff, and other soft tissue, as compared to conventional anterograde approach.
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Affiliation(s)
- Süleyman Semih Dedeoğlu
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Yunus İmren
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Haluk Çabuk
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Ali Çağrı Tekin
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Mustafa Çağlar Kır
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Hakan Gürbüz
- Department of Orthopaedics and Traumatology, Okmeydanı Research and Training Hospital, İstanbul, Turkey
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Çabuk H, İmren Y, Tekin AÇ, Dedeoğlu SS, Gürbüz H. High Varus Angle and Lower Posterior Tibial Slope Associated with PCL Injury in Cruciate Retaining Total Knee Arthroplasty: An MRI Study. J Knee Surg 2018; 31:277-283. [PMID: 28561157 DOI: 10.1055/s-0037-1603334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The posterior tibial slope (PTS) is important for performing a tibial cut that does not injure the posterior cruciate ligament (PCL). In this study, the amount of PCL fibers sacrificed under simulated tibial cuts with varying posterior inclinations was evaluated using magnetic resonance images (MRIs) of osteoarthritic varus knees. Knee X-rays, orthoroentgenograms, and MRIs of 113 Kellgren and Lawrence grades 3 to 4 osteoarthritic knees were included. Four different simulated tibial cuts were performed at 0, 3, 5 degrees and parallel to the tibia plateau 3 mm below of the most defective part of the cartilage in the medial plateau. Correlations between the PCL avulsion amount and the PTS and varus alignment of the lower extremity were analyzed for all four simulated tibial cut levels. The maximum amount of PCL was preserved with a 0-degree tibial cut in patients with a PTS of more than 8 degrees. With increased tibial cut angles, the posterior slope resulted in an increased amount of avulsed PCL. Although the amount of avulsed PCL was proportional with the varus alignment, it was inversely proportional with the sagittal slope. The number of injured PCLs also increased as the slope of the tibial cuts increased. Patients with mild varus alignments and high PTSs are more suitable for cruciate retaining total knee arthroplasty.
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Affiliation(s)
- Haluk Çabuk
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Yunus İmren
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Ali Çağrı Tekin
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Süleyman Semih Dedeoğlu
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Hakan Gürbüz
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
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Tekin AÇ, Çakar M, Esenyel CZ, Adaş M, Bayraktar MK, Özcan Y, Saygılı MS, Tekin ZN. An evaluation of meniscus tears in lateral tibial plateau fractures and repair results. J Back Musculoskelet Rehabil 2016; 29:845-851. [PMID: 27062468 DOI: 10.3233/bmr-160698] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 02/04/2023]
Abstract
BACKGROUND Soft tissue injuries may co-occur with tibial plateau fractures. These injuries may include medial or lateral ligament ruptures, peroneal nerve lesions, anterior cruciate ligament ruptures, and meniscus tears. OBJECTIVE The aim of this study was to investigate the frequency of meniscus tears in lateral tibial plateau fractures and to evaluate the clinical and radiological results of meniscus repairs. MATERIALS AND METHOD The study included 19 patients who underwent surgery for a closed lateral tibial plateau fracture. Anteroposterior and lateral radiographs of the knee, followed by magnetic resonance imaging (MRI) examinations, were undertaken for all cases. The clinical and radiological evaluation of the surgical treatment results was performed according to the Rasmussen criteria. RESULTS Meniscus lesions were found in 10 (52.6%) patients. Nine meniscus tears were found in patients with type 2 fractures, and one meniscus tear was found in a patient with a type 3 fracture. All of the menisci were separated from the peripheral capsule adhesion point. On the MRI examination during follow-up, all of the repaired lateral menisci were determined to be in their original anatomic location. CONCLUSION For successful outcomes in lateral plateau fractures, it is essential to determine whether there is a meniscus tear. In cases with meniscus tears, meniscus repair can be easily performed and should be considered because it has a positive impact on the treatment outcome.
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Affiliation(s)
- Ali Çağrı Tekin
- Orthopaedics and Traumatology Clinic, Okmeydanı Research and Training Hospital, İ!stanbul, Turkey
| | - Murat Çakar
- Orthopaedics and Traumatology Clinic, Okmeydanı Research and Training Hospital, İ!stanbul, Turkey
| | - Cem Zeki Esenyel
- Orthopaedics and Traumatology Clinic, Okmeydanı Research and Training Hospital, İ!stanbul, Turkey
| | - Müjdat Adaş
- Orthopaedics and Traumatology Clinic, Okmeydanı Research and Training Hospital, İ!stanbul, Turkey
| | - Mehmet Kürşad Bayraktar
- Orthopaedics and Traumatology Clinic, Okmeydanı Research and Training Hospital, İ!stanbul, Turkey
| | - Yusuf Özcan
- Orthopaedics and Traumatology Clinic, Okmeydanı Research and Training Hospital, İ!stanbul, Turkey
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Tekin AÇ, Çabuk H, Büyükkurt CD, Dedeoğlu SS, İmren Y, Gürbüz H. Inferior hip dislocation after falling from height: A case report. Int J Surg Case Rep 2016; 22:62-5. [PMID: 27058153 PMCID: PMC4832043 DOI: 10.1016/j.ijscr.2016.02.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 01/16/2023] Open
Abstract
Traumatic inferior hip dislocations are high energy traumas with multiple organ damage. Traumatic inferior hip dislocation is the least common of all hip dislocation. The ischial type is more common than the obturator type.
Introduction Traumatic inferior hip dislocation is the least common of all hip dislocations. Adult inferior hip dislocations usually occur after high-energy trauma, very few cases are reported without fracture. Presentation of case A 26-year-old female was brought to the emergency department with severe pain in the left hip, impaired posture and restricted movement following a fall from 15 m height. The hip joint was fixed in 90° flexion, 15° abduction, and 20° external rotation. No neurovascular impairment was determined. On radiologic examination, a left ischial type inferior hip dislocation was detected. Hemorrhagic shock which developed due to acute blood loss to thoracic and abdominal cavity and patient died at third hour after she was brought to the hospital. Discussion Traumatic hip dislocations have high morbidity and mortality rates due to multiple organ damage, primarily of the extremities, chest and abdomen. In the treatment of traumatic hip dislocation, closed reduction is recommended through muscle relaxation under general anesthesia or sedation. This procedure should be applied before any intervention for concomitant extremity injuries. A detailed evaluation on emergency presentation, a multi-disciplinary approach and early diagnosis with the rapid application of imaging methods could be life-saving for such patients.
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Affiliation(s)
- Ali Çağrı Tekin
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul 34384, Turkey.
| | - Haluk Çabuk
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul 34384, Turkey.
| | - Cem Dinçay Büyükkurt
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul 34384, Turkey.
| | - Süleyman Semih Dedeoğlu
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul 34384, Turkey.
| | - Yunus İmren
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul 34384, Turkey.
| | - Hakan Gürbüz
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul 34384, Turkey.
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Tekin AÇ, Çabuk H, Dedeoğlu SS, Saygılı MS, Adaş M, Esenyel CZ, Büyükkurt CD, Tonbul M. The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities. SICOT J 2016; 2:11. [PMID: 27163100 PMCID: PMC4849258 DOI: 10.1051/sicotj/2016005] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim: To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame) in patients with lower extremity shortness and deformity. Materials and methods: The study comprised 17 patients (14 male, 3 female) who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure’s level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes. Results: The mean age of the patients was 24.58 years (range, 5–51 years). The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6–31 months) from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1–6 cm). The mean duration of fixator application was 202.7 days (range, 104–300 days). The mean External Fixator Index was 98 days/cm (range, 42–265 days/cm). The mean Distraction Index was 10.49 days/cm (range, 10–14 days/cm). Conclusion: The computer-assisted external fixator system (spider frame) achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity.
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Affiliation(s)
- Ali Çağrı Tekin
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital 34384 Istanbul Turkey
| | - Haluk Çabuk
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital 34384 Istanbul Turkey
| | - Süleyman Semih Dedeoğlu
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital 34384 Istanbul Turkey
| | - Mehmet Selçuk Saygılı
- Metin Sabanci Baltalimani Bone Disease Training and Research Hospital 34470 Istanbul Turkey
| | - Müjdat Adaş
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital 34384 Istanbul Turkey
| | - Cem Zeki Esenyel
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital 34384 Istanbul Turkey
| | - Cem Dinçay Büyükkurt
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital 34384 Istanbul Turkey
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Adaş M, Tekin AÇ, Bayraktar MK, Çakar M, Aslan S, Esenyel CZ. Effects of the lower extremity external fixators on the sexual life of males. Acta Orthop Traumatol Turc 2016; 50:76-81. [PMID: 26854053 DOI: 10.3944/aott.2016.15.0144] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In tibial fractures, the use of an external fixator (EF) may be associated with sexual dysfunction (SD) in sexually active male patients. We aimed to investigate the influence of EF applied for tibial fracture on the sexual life in male patients. METHODS We retrospectively evaluated 137 male patients who presented with tibial fractures and underwent surgical intervention with unilateral or circular EF. The patients completed the Brief Sexual Function Inventory (BSFI) form during the interview. We evaluated the incidence of the development of SD and the severity of SD with the use of an EF, and the relation with the type of EF and SD was investigated. The responses were compared with the results of the completed BSFI forms of 119 male patients who were treated with internal fixation (IF) for tibial fractures. RESULTS In total, 108 patients (mean age, 42.8 years) treated with EF accepted the invitation and filled the form. The score of those patients were worse compared with that of the patients who were treated with IF (p<0.001). Postoperative sexual functions were the same with the preoperative sexual function in 12 patients (11%). However, the postoperative scores were decreased in 96 (89%) patients, which meant that the sexual functioning was impaired. None of the patients reported persistent SD. CONCLUSION EF in the cruris may impair sexual functions in males. The rate of SD was higher in male patients who were treated with EF. Thus, SD might be associated with physical, psychological, and social limitations caused by EF.
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Affiliation(s)
- Müjdat Adaş
- Okmeydanı Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Ali Çağrı Tekin
- Okmeydanı Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Mehmet Kürşad Bayraktar
- Okmeydanı Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Murat Çakar
- Okmeydanı Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Samet Aslan
- Okmeydanı Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Cem Zeki Esenyel
- Okmeydanı Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey
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Çabuk H, Dedeoğlu SS, Adaş M, Tekin AÇ, Seyran M, Ayanoğlu S. Medial Spike and Obesity Associate with Open Reduction in Type III Supracondylar Humeral Fracture. Acta Chir Orthop Traumatol Cech 2016; 83:102-105. [PMID: 27167414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED PURPOSE OF THE STUDY Although supracondylar humeral fractures represent a major part of the pediatric fractures, no classification system or radiological characteristics describes which supracondylar fractures require open reduction. We aim to evaluate the factors that lead us to perform open reduction during operation. MATERIAL AND METHODS We retrospectively evaluated 57 patients who underwent operation for type III supracondylar fracture, and divided them into two groups; those with open reduction and internal fixation, and those with closed reduction and percutaneous fixation. The two groups were compared based on age, gender, BMI by age, medial spike angle of the fracture, medial spike-skin distance and rotation angle between the fractured fragments. RESULTS Of all patients, 46 (81.71%) underwent closed reduction and percutaneous fixation (CRPF) and 11 (19.29%) were treated with open reduction and internal fixation (ORIF). BMI by age was remarkably higher in the ORIF group (p = 0.00). And medial spike angle was smaller in the ORIF group (p = 0.014). DISCUSSION Closed reduction and percutanous fixation is the main treatment of supracondylar humeral fractuers. Open reduction in supracondylar humeral fractures could be associate with complications and cosmetic lesions. Many studies indicates that obesity is high risk factor for complex fractures as well as preoperative and postoperative complications. A prominant medial spike could associate with muscle entrapment, and obliquity of the fracture line. It could be also an indirect finding of instablity of the fracture. CONCLUSION We suggest that a smaller medial spike angle and a higher BMI in children with Type III supracondylar humeral fractures may require open reduction, and it is unreasonable to avoid open reduction in cases where closed reduction is not achieved. KEY WORDS supracondylar humerus, open reduction, obesity, medial spike angle.
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Affiliation(s)
- H Çabuk
- Okmeydanı Training and Research Hospital, Department of Orthopedics and Traumatology, İstanbul, Türkiye
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Tekin AÇ, Çabuk H, Dedeoğlu SS, Saygılı MS, Adaş M, Büyükkurt CD, Gürbüz H, Çakar M, Tekin ZN. Anterograde Headless Cannulated Screw Fixation in the Treatment of Medial Malleolar Fractures: Evaluation of a New Technique and Its Outcomes. Med Princ Pract 2016; 25:429-34. [PMID: 27287216 PMCID: PMC5588438 DOI: 10.1159/000447426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 06/06/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the functional and radiological outcomes of anterograde headless cannulated screw fixation for medial malleolar fractures. SUBJECTS AND METHODS This study included 12 patients (8 males, 4 females; age 27-55 years) with medial malleolar type B fractures according to the Herscovici fracture classification who had undergone anterograde headless cannulated screw fixation surgery between 2012 and 2014. Seven had an isolated medial malleolar fracture and 5 a bimalleolar fracture. All of the bimalleolar fractures were classified as 44-B2 based on the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification. Postoperatively, bone union was evaluated on direct radiographs at the final follow-up examination. The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used for clinical evaluation. RESULTS The mean follow-up period was 17.2 ± 5.3 months (range 12-23). Full union was achieved in all fractures. The mean time to union was 3.4 ± 1.5 months (range 2-5). No instability, loss of reduction, non-union or infection was observed in any patient. The mean AOFAS score was 95.0 ± 5.4 (range 87-99). Based on the AOFAS score, 4 patients showed good results and 8 excellent results. The mean time to return to the previous level of activity was 4.0 ± 2.5 months (range 2-5). CONCLUSION In this study, anterograde headless cannulated screw fixation yielded good clinical outcome in the surgical treatment of Herscovici type B fractures.
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Affiliation(s)
- Ali Çağrı Tekin
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Darıca, Turkey
- *Ali Çağrı Tekin, MD, Department of Orthopaedics and Traumatology, Okmeydanì Training and Research Hospital, TR—34384 Istanbul (Turkey), E-Mail
| | - Haluk Çabuk
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Darıca, Turkey
| | - Süleyman Semih Dedeoğlu
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Darıca, Turkey
| | - Mehmet Selçuk Saygılı
- Metin Sabanci Baltalimani Bone Disease Training and Research Hospital, Istanbul, Darıca, Turkey
| | - Müjdat Adaş
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Darıca, Turkey
| | - Cem Dinçay Büyükkurt
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Darıca, Turkey
| | - Hakan Gürbüz
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Darıca, Turkey
| | - Murat Çakar
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Darıca, Turkey
| | - Zeynep Nilüfer Tekin
- Department of Radiology, Darıca Farabi Government State Hospital, Darıca, Turkey
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Tekin AÇ, Saygılı MS, Adaş M, Çabuk H, Arslan SM, Dedeoğlu SS. Outcome of Type 3 Open Tibial Diaphyseal Fractures Managed with a Limb Reconstruction System: Analysis of a 49-Patient Cohort. Med Princ Pract 2016; 25:270-5. [PMID: 26655399 PMCID: PMC5588381 DOI: 10.1159/000443257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 12/06/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate functional and radiological results following treatment with the single-plane external fixator limb reconstruction system (LRS) for open tibial diaphyseal fractures resulting from high-energy trauma. SUBJECTS AND METHODS From a total of 62 patients who were operated on between 2011 and 2014 for open tibial diaphyseal fractures resulting from high-energy trauma, 50 tibias from 49 patients (males: 32, females: 17) were classified as type 3 according to the Gustilo-Anderson open fracture classification, and definitive treatment was applied with the LRS. The patients ranged in age from 20 to 36 years. Time to union, time of external fixator usage, complications and functional results according to the Johner-Wruhs criteria were recorded. RESULTS The mean follow-up period was 23 ± 12 months (range: 11-44). Of the 50 tibias, full union was achieved with the LRS in 48 (96%). No shortness or deformity was observed in any patient. Knee and ankle range of movement were measured as full in all patients at the final follow-up examination after removal of the LRS. The mean time to union was 20.4 ± 4 weeks (range: 16-24). The mean time of external fixator use was 20 weeks (range: 16-24 weeks). CONCLUSION In this study, for the definitive treatment of open tibia diaphyseal fractures, the LRS was an optimal and safe choice that offered single-stage surgery.
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Affiliation(s)
- Ali Çağrı Tekin
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
- *Dr. Ali Çağrı Tekin, Department of Orthopaedics and Traumatology, Okmeydanì Training and Research Hospital, Darülaceze Avenue, No. 25, TR—34384 Şişli/Istanbul (Turkey), E-Mail
| | - Mehmet Selçuk Saygılı
- Metin Sabancı Baltalimanı Bone Disease Training and Research Hospital, Istanbul, Turkey
| | - Müjdat Adaş
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Haluk Çabuk
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Samet Murat Arslan
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Süleyman Semih Dedeoğlu
- Department of Orthopaedics and Traumatology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
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Gürbüz H, Çakar M, Adaş M, Tekin AÇ, Bayraktar MK, Esenyel CZ. Measurement of the knee joint line in Turkish population. Acta Orthop Traumatol Turc 2015; 49:41-4. [PMID: 25803252 DOI: 10.3944/aott.2015.14.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of the present study was to determine the knee joint line level by its distance to the adductor tubercle and the apex of the fibular head in the Turkish population. METHODS The study included 117 knees of 108 patients (63 males, 45 females; mean age: 31.3 years, range: 16 to 82 years). Femoral width and the distance from the apex of the fibular head to the joint line as well as the distance from the adductor tubercle to the joint line were measured on anteroposterior radiographs. RESULTS Mean femoral width was 87.2 mm. The average distance from the adductor tubercle to the joint line was 47.9 mm and from the fibular head to the joint line was 20.5 mm. A linear correlation was found between the distance from the adductor tubercle to the joint line and femoral width, with a ratio of 0.55. There was no significant correlation between the distance from the fibular head to the joint line and femoral width. CONCLUSION There was a linear correlation between the femoral width and the adductor tubercle-joint line distance irrespective of any factors such as age, gender and height. Therefore, the adductor tubercle can be used as a reliable landmark to determine the joint line level for easy evaluation and measurement during surgery.
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Affiliation(s)
- Hülya Gürbüz
- Department of Anatomy, Faculty of Medicine, İstanbul Bilim University, İstanbul, Turkey
| | - Murat Çakar
- Department of Orthopedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Müjdat Adaş
- Department of Orthopedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Ali Çağrı Tekin
- Department of Orthopedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Kürşad Bayraktar
- Department of Orthopedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Cem Zeki Esenyel
- Department of Orthopedics and Traumatology, Okmeydanı Training and Research Hospital, İstanbul, Turkey
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