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Kürüm H, Tosun HB, Aydemir F, Ayas O, Orhan K, Key S. Intertrochanteric Femoral Fractures: A Comparative Analysis of Clinical and Radiographic Outcomes Between Talon Intramedullary Nail and Intertan Nail. Cureus 2023; 15:e50877. [PMID: 38259364 PMCID: PMC10801105 DOI: 10.7759/cureus.50877] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Hip fractures in the elderly constitute a significant health concern, and their incidence is on the rise. It has been reported that intertrochanteric femoral fractures comprise a large portion of hip fractures, and they are especially prevalent among women. Over 75% of these types of fractures in the elderly occur as a result of simple falls. Surgical intervention must be performed for these fractures to expedite the healing process in patients. The application of a proximal femoral nail (PFN) is conducted using a minimally invasive technique after the fracture has been reduced using closed techniques. This technique maintains the fracture hematoma while minimizing the occurrence of consequences such as surgical trauma, hemorrhaging, infection, and issues with the wound site. This study aimed to assess the radiologic and functional outcomes among the groups following surgical procedures utilizing two distinct PFNs. Methods Between November 2021 and June 2023, a total of 96 individuals (38 males and 58 females) who underwent surgery for ITF using PFN were included in the study. Our surgical team utilized the Talon™ DistalFix™ PFN system (Orthopedic Designs North America Inc., FL, USA) and the Trigen InterTAN® nail (Smith & Nephew). Results The surgery time (number of scopes) for the Talon PFN was recorded as 25 (25-30), while it was 30 (30-35) in the InterTAN group (p<0.001). No nail protrusion was observed in the InterTAN group, whereas nail protrusion was observed in 12 patients (31.6%) in the Talon PFN group (p<0.001). Nail jamming was observed in two (5.3%) patients in the Talon PFN group, while none was observed in the InterTAN group (p<0.07). Conclusion In ITF fractures, the InterTAN nail is a more reliable implant. The shorter surgery time, reduced radiation exposure, and more minimally invasive nature of the Talon PFN might be preferred for geriatric patient populations with comorbidities where prolonged anesthesia could elevate mortality risks or for fractures of two or three pieces (Evans-Jansen Type 1 and Type 2). However, for more unstable fractures (Evans-Jensen Type 3) and in the active elderly patient group, we recommend the use of the InterTAN nail.
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Affiliation(s)
- Hüseyin Kürüm
- Orthopaedics and Traumatology Department, Ergani State Hospital, Ministry of Health, Diyarbakir, TUR
| | | | - Faruk Aydemir
- Emergency Department, Elazığ Fethi Sekin Training and Research Hospital, Elazığ, TUR
| | - Orhan Ayas
- Orthopaedics and Traumatology Department, Elazığ Fethi Sekin Training and Research Hospital, Elazığ, TUR
| | - Kübra Orhan
- Physical Therapy and Rehabilitation Department, İnönü University Turgut Özal Medical Center, Malatya, TUR
| | - Sefa Key
- Orthopedics and Traumatology Department, Firat University Hospital, Firat University, Elazığ, TUR
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Kaya O, Tosun HB, Kürüm H, Serbest S, Uludağ A, Ayas O. Comparative Study of Minimally Invasive Plate Osteosynthesis (MIPO) and Intramedullary Nailing (IMN) for Treating Extraarticular Distal Tibial Fractures: Clinical and Radiological Outcomes. Med Sci Monit 2023; 29:e942154. [PMID: 37885268 PMCID: PMC10588510 DOI: 10.12659/msm.942154] [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] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/02/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Treatment of extra-articular distal tibial fractures is problematic owing to limited soft tissue cover, poor vascularity of the location, and adjacency to the ankle, and thus continues to be controversial. This study aimed to compare clinical and radiological outcomes in 69 patients with extra-articular distal tibia fractures treated with minimally invasive plate osteosynthesis (MIPO) and an interlocking intramedullary nail (IMN). MATERIAL AND METHODS Sixty-nine patients, with mean of age 39.8±18.3 years, were retrospectively evaluated. Thirty-five patients were treated with IMN, and 34 patients were treated with MIPO. Clinical and radiological outcomes were evaluated. RESULTS The average follow-up was 13.3±6 months and union time was 16.2±5.4 weeks. Nonunion was observed in only 4.3% of patients treated with MIPO (P=0.114). Non-acceptable malalignment of extremity was observed in 4.3% of patients with IMN and 7.2% of patients with MIPO. There were no significant differences in union time, nonunion, surgical timing, operating time, malalignment, and complications between groups (P>0.05). The mean American Orthopaedic Foot and Ankle Society (AOFAS) surgery score was 95.8±5 in IMN and 91.9±14.3 in MIPO. AOFAS, Tenny-Wiss radiological, and Ovadia-Beals clinical scores were better in IMN than MIPO (P=0.019, P=0.03, P=0.02, respectively). Mean time of full weight-bearing and of return to daily life with IMN was significantly shorter than with MIPO (P.
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Affiliation(s)
- Oğuz Kaya
- Department of Orthopedics and Traumatology, Health Sciences University, Faculty of Medicine, Elazig Fethi Sekin City Hospital, Elazig, Turkey
| | - Hacı Bayram Tosun
- Department of Orthopedics and Traumatology, Health Sciences University, Faculty of Medicine, Elazig Fethi Sekin City Hospital, Elazig, Turkey
| | - Hüseyin Kürüm
- Department of Orthopedics and Traumatology, Ergani State Hospital, Diyarbakır, Turkey
| | - Sancar Serbest
- Department of Orthopedics and Traumatology, Kırıkkale University, Faculty of Medicine, Kırıkkale, Turkey
| | - Abuzer Uludağ
- Department of Orthopedics and Traumatology, Adiyaman University, Faculty of Medicine, Adiyaman, Turkey
| | - Orhan Ayas
- Department of Orthopedics and Traumatology, Health Sciences University, Faculty of Medicine, Elazig Fethi Sekin City Hospital, Elazig, Turkey
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Abstract
Background and objective Bone marrow edema (BME) is a rare condition caused by insufficient osseous blood supply and may result in severe pain that has adverse effects on patients’ life. To date, various conservative treatments have been recommended for the treatment of BME, including analgesics, immobilization of the affected extremity, and iloprost infusion. The aim of this retrospective study was to investigate the effectiveness of parenteral iloprost therapy in the treatment of BME detected in different skeletal locations. Materials and methods This retrospective study included 23 patients (17 men and six women) with BME who were classified as stage I-III according to the Association Research Circulation Osseous (ARCO) classification. BME was localized to the proximal femur in 13 (56.5%), the distal femur in four (17.4%), tarsal bone in four (17.4%), and tibial plateau in two (8.7%) patients. The mean age of the patients was 46.7 years and all the patients were evaluated with the Visual Analog scale (VAS), Functional Mobility Scale (FMS), and MRI. Results A significant improvement was observed in the post-treatment VAS and FMS scores of all patients compared to their pre-treatment scores. Moreover, the edema regressed completely in 60.9% of the patients at three months of MRI control. No serious side effects were observed during the treatment in any of the patients. However, transient side effects including headache, arrhythmia, and flushing were observed in five patients. Conclusion The present study indicated that iloprost therapy is an effective and safe option in the treatment of BME patients, particularly in the reduction of severe pain that has adverse effects on patients’ social life, regardless of ARCO staging. Moreover, this therapy could be particularly useful in reducing pain, improving functional recovery, and achieving complete regression of the edema on MRI in ARCO stage I-II patients.
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Affiliation(s)
| | - Abuzer Uludağ
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Sukru Demir
- Orthopaedics and Traumatology, Fırat University, Elazıg, TUR
| | - Sancar Serbest
- Orthopaedics and Traumatology, Kırıkkale University Faculty of Medicine, Kirikkale, TUR
| | - Mehmet Mete Yasar
- Orthopaedics and Traumatology, Adıyaman University Faculty of Medicine, Adıyaman, TUR
| | - Kadir Öznam
- Orthopaedics and Traumatology, Medipol University School of Medicine, Istanbul, TUR
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Uludağ A, Tosun HB, Aslan TT, Uludağ Ö, Gunay A. Comparison of Three Different Approaches in Pediatric Gartland Type 3 Supracondylar Humerus Fractures Treated With Cross-Pinning. Cureus 2020; 12:e8780. [PMID: 32596093 PMCID: PMC7314373 DOI: 10.7759/cureus.8780] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Although closed reduction and percutaneous pinning are the accepted treatment approaches in pediatric humerus supracondylar fractures, the treatment approach in fractures without closed reduction remains unclear. This study compared the results of three different cross-pinning treatment methods. Materials and methods A total of 62 patients (1-13 years old) who were operated for Gartland type 3 humerus supracondylar fractures between 2007 and 2016 were evaluated retrospectively. Of the patients evaluated, 24 patients had closed reduction, 25 patients had direct reduction from the medial, and 13 patients had direct reduction from the lateral and cross-pinning. The functional and cosmetic results of the patients were evaluated according to Flynn's criteria. In addition, the Baumann angle, lateral capitellohumeral angle (LCHA), and postoperative complications were compared among groups. Results Both functional and cosmetic results and the Bauman and LCHA angles were similar in all three groups. In patients with open reduction, the control duration was significantly longer than that in patients with closed reduction, and this difference was due to a recent increase in the surgeons' preference for closed surgery. Two patients underwent pin site infection and two patients developed nerve palsy. Only the first patient who developed ulnar nerve palsy recovered during follow-up. Secondary surgery was applied to the other patient who developed brachial artery occlusion with ulnar and median nerve paralysis, and they recovered during follow-up. Three patients who underwent open surgery from the medial, along with the two patients who had undergone open surgery, developed pinhole infection. These patients were subsequently recovered with antibiotherapy without further complications. A patient who underwent open lateral surgery developed compartment syndrome and fasciotomy was performed. Conclusion Closed reduction and percutaneous pinning are generally accepted approaches in the treatment of pediatric humerus supracondylar type 3 fractures. However, in cases where closed reduction cannot be achieved, pinning with the medial approach and taking the ulnar nerve and medial colon is a reliable method to avoid both ulnar nerve injury and cubitus varus.
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Affiliation(s)
- Abuzer Uludağ
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | | | - Talip Teoman Aslan
- Orthopaedics and Traumatology, Darıca Farabi State Hospital, Kocaeli, TUR
| | - Öznur Uludağ
- Anesthesiology and Reanimation, Adıyaman University Faculty of Medicine, Adıyaman, TUR
| | - Abdussamed Gunay
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
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Uludağ A, Tosun HB, Çelik S, Serbest S, Kayalar M, Aytaç G, Sindel M, Erbay Elibol FK, Demir T. Comparison of various tendon repair techniques in extansor zone 3 injuries: an experimental biomechanical cadaver study. Arch Orthop Trauma Surg 2020; 140:583-590. [PMID: 32130480 DOI: 10.1007/s00402-020-03384-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/13/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare five different repair techniques for extensor tendon zone III modified Kessler (MK), double-modified Kessler (DMK), modified Kessler epitendinous (MKE), double-modified Kessler epitendinous (DMKE), and running-interlocking horizontal mattress (RIHM) in terms of shortening, stiffness, gap formation, and ultimate load to failure. METHODS A total of 35 human cadaver fingers were randomly assigned to five suture techniques with 7 fingers each and were tested under dynamic and static loading conditions. RESULTS DMK was found to be superior over MK in terms of ultimate load to failure (36 N vs. 24 N, respectively), shortening (1.75 vs. 2.20 mm, respectively) and gap formation. However, these two methods had similar characteristics in terms of stiffness. The addition of epitendinous sutures to the repair methods resulted in approximately 40% increase in ultimate load to failure, whereas epitendinous sutures had no effect on shortening. DMKE was found to be superior over MKE in terms of shortening (1.77 vs. 2.22 mm, respectively). However, these two methods had similar characteristics in terms of mean ultimate load to failure and stiffness. RIHM was found to be superior over the other four methods in terms of ultimate load to failure (89 N), stiffness, and shortening (0.75 mm). CONCLUSION RIHM was found to be stronger and more durable for extensor tendon zone III than the other techniques in terms of ultimate load to failure and stiffness.
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Affiliation(s)
- Abuzer Uludağ
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02100, Adiyaman, Turkey.
| | - Hacı Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, 02100, Adiyaman, Turkey
| | - Suat Çelik
- Department of Orthopaedics and Traumatology, Private Park Hospital, Adiyaman, Turkey
| | - Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kirikkale, Turkey
| | - Murat Kayalar
- Department of Hand and Microsurgery, Orthopaedics and Traumatology (EMOT) Hospital, Kahramanlar, Izmir, Turkey
| | - Güneş Aytaç
- Department of Anatomy, Faculty of Medicine, Yuksek Ihtisas University, Ankara, Turkey
| | - Muzaffer Sindel
- Department of Anatomy, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Fatma Kübra Erbay Elibol
- Department of Micro and Nanotechnology, TOBB University of Economics and Technology, Ankara, Turkey
| | - Teyfik Demir
- Department of Mechanical Engineering, TOBB University of Economics and Technology, Ankara, Turkey
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Uludağ A, Tosun HB, Yasar MM, Gunay A, Aydin Turk B, Uludağ Ö. The Effect of Tourniquet Usage and Anesthesia Method on Prognosis in the Treatment of Dorsal Wrist Ganglion Cysts by Open Surgery. Cureus 2019; 11:e5981. [PMID: 31803563 PMCID: PMC6874420 DOI: 10.7759/cureus.5981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction Ganglion cysts are the most common soft tissue masses seen on the wrist, which often cause pain or cosmetic complaints. The treatment of these masses includes intra-cystic injections or surgery. Recurrence rates are very high in surgical or non-surgical treatment. Inadequate excision for recurrence after surgery is blamed; however, the reasons for the recurrence still remain mysterious. Objectives In this study, the effect of anesthesia selection and tourniquet use on the dorsal wrist ganglion cysts in open surgery was investigated. Materials and methods Patients with dorsal wrist ganglion cysts, who were operated with open surgery between 2015 and 2018 and who had at least six months after the surgery, were examined. The patients were divided into two groups: patients who underwent surgery without tourniquet with local anesthesia and patients operated with tourniquet with general or regional anesthesia. Age, sex, cause of operation, visual analog scale (VAS) scores before and after surgery, limitation of movement, postoperative complications, and recurrence were compared. Results There was no significant difference between the groups in terms of causes of surgery, recurrence rates, preoperative and postoperative limitations of movement, and complications. In terms of age, the group operated with local anesthesia and without tourniquet was significantly larger. There was also no significant difference between the groups in terms of preoperative pain. Postoperative pain was significantly less in the group operated by tourniquet with general-regional anesthesia. Conclusion There is no significant difference in the recurrence and complications between patients operated under local anesthesia without tourniquets and patients operated with tourniquets under general or regional anesthesia during the open excision of the dorsal wrist ganglion cysts. However, it should be kept in mind that postoperative pain does not diminish in later ages, especially in cases of ganglion cysts, and other pathologies may also potentially cause pain in the wrist.
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Affiliation(s)
- Abuzer Uludağ
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | | | - Mehmet Mete Yasar
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Abdussamed Gunay
- Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Bilge Aydin Turk
- Pathology, Adiyaman University Faculty of Medicine, Adiyaman, TUR
| | - Öznur Uludağ
- Anesthesiology and Reanimation, Adıyaman University Faculty of Medicine, Adıyaman, TUR
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Uludağ A, Tosun HB, Çiçek N, Şirik M, Uludağ Ö, Atiç R. Yaralanma Sonrası Ekstremitelerin Yumuşak Dokusunda Gözlenen Yabancı Cisimlere Cerrahi Yaklaşım. Dicle Tıp Dergisi 2019. [DOI: 10.5798/dicletip.539936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Serbest S, Tiftikçi U, Tosun HB, Kısa Ü. The Irisin Hormone Profile and Expression in Human Bone Tissue in the Bone Healing Process in Patients. Med Sci Monit 2017; 23:4278-4283. [PMID: 28869754 PMCID: PMC5597035 DOI: 10.12659/msm.906293] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Whether or not there is a relationship between the newly-discovered irisin hormone and bone healing is not yet known. The aim of this study was to investigate what effect irisin hormone has on the bone healing process. Material/Methods The study included 21 adult patients with a diagnosed fracture of the lower extremity (femur or tibia). Informed consent was obtained from all the patients. A total of four venous blood samples were taken from the patients: before fracture stabilization, then postoperatively on days 1, 10, and 60. In patients with femoral neck fracture who had hip prosthesis applied, bone tissue samples were taken from the removed femur head and irisin was determined immunohistochemically in muscle biopsies taken from the same patients. Results In analysis, it was revealed that the mean value of irisin 60 days after operation is significantly higher than the values of irisin before operation, 1 day after operation, and 15 day after operation (p<0.001, p<0.001, p<0.001, respectively). Intense staining was observed in compact bone tissue, muscle tissue, and in hypertrophic vascular endothelium within the Havers canal. Conclusions The level of irisin hormone increased in the bone union process and affects fracture healing due to irisin receptors in human bone tissue.
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Affiliation(s)
- Sancar Serbest
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Uğur Tiftikçi
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Hacı Bayram Tosun
- Department of Orthopedics and Traumatology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
| | - Üçler Kısa
- Department of Biochemistry, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
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Isyar M, Gumustas SA, Yilmaz I, Sirin DY, Tosun HB, Mahirogullari M. Are We Economically Efficient Enough to Increase the Potential of in Vitro Proliferation of Osteoblasts by Means of Pharmacochemical Agents? Open Orthop J 2016; 10:420-430. [PMID: 27708738 PMCID: PMC5034028 DOI: 10.2174/1874325001610010420] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/16/2016] [Accepted: 06/19/2016] [Indexed: 02/07/2023] Open
Abstract
Background: The aim of this study was to test the necessity of using expensive and unaccesible pharmacological-chemical agents in the proliferation of bone tissue cultures and in the induction of mineralized matrix formation to increase the osteogenic effect. Methods: For this purpose, human primary cell cultures were prepared and then divided into two groups. Whereas the cells in group I were fed with an osteoblast stimulator medium containing Dulbecco’s Modified Eagle Medium (DMEM) and β-glycerophosphate, the cells in group II were fed with DMEM containing dexamethasone and 2-phospho-L-ascorbic acid trisodium salt. Both groups were evaluated in terms of viability, toxicity, and proliferation and then compared in terms of cell surface morphology through inverted light and environmental scanning electron microscopy. In addition to immunoflow cytometric analyses, the effects of alkaline phosphatase activities were evaluated using the spectrophotometric method to examine the osteoblastic activities. Costs were calculated in the currency of the European Union (Euros). The Tukey Honestly Significant Difference test was used to reach the statistical evaluation of the data after the analysis of variance. Results: It was reported that the level of the alkaline phosphates was higher in group I compared to group II. It was observed that the surface morphology quality, the number of living cells, and proliferation were higher in group II and that the results were deemed statistically significant. Conclusion: It was found that the 2-phospho-L-ascorbic acid trisodium salt and dexamethasone mixture was as effective as the expensive commercial kits on the osteogenic effect on human primary bone tissue.
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Affiliation(s)
- Mehmet Isyar
- Department of Orthopaedic and Traumatology, Istanbul Medipol University School of Medicine, 34214, Istanbul, Turkey
| | - Seyit Ali Gumustas
- General Secretariat of the Public Hospitals Union, Republic of Turkey, Ministry of Health, 59100, Tekirdag, Turkey
| | - Ibrahim Yilmaz
- Department of Pharmacovigilance, Materiovigilance and Rational Use of Drugs, State Hospital, Republic of Turkey, Ministry of Health, 59100, Tekirdag, Turkey
| | - Duygu Yasar Sirin
- Department of Molecular Biology and Genetic, Namik Kemal University, Faculty of Arts and Sciences, 59100, Tekirdag, Turkey
| | - Hacı Bayram Tosun
- Department of Orthopaedics and Traumatology, Adiyaman University School of Medicine, 02000, Adıyaman, Turkey
| | - Mahir Mahirogullari
- Department of Orthopaedic and Traumatology, Istanbul Medipol University School of Medicine, 34214, Istanbul, Turkey
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Çelik S, Uludağ A, Tosun HB, Serbest S, Gürger M, Kılıç S. Unicameral (simple) and aneurysmal bone cysts: the effect of insufficient curettage on recurrence. Pan Afr Med J 2016; 24:311. [PMID: 28154666 PMCID: PMC5267782 DOI: 10.11604/pamj.2016.24.311.9624] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/26/2016] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Curettage of the cyst and bone grafting are the most common methods used in the treatment of unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC). Recurrence of these cysts is often associated with insufficient curettage of the cyst during surgery. In this study, we aimed to evaluate the effect of insufficient curettage on recurrence in patients with UBC and ABC. METHODS The retrospective study included 18 patients with UBC and 14 patients with ABC that were surgically treated by curettage and bone grafting in our clinic between 2006-2013. Mean age was 19.80 (range, 4-50) years in the patients with UBC and 21.76 (range, 4-56) in the patients with ABC. The diagnosis of the cysts was established both clinically and radiologically. Mean follow-up period was 36 (range, 6-60) months both in the patients with UBC and ABC. The patients with recurrence underwent a second curettage and grafting procedure. Healing and recurrence were evaluated according to modified Neer's scale. RESULTS Recurrence occurred in 8 patients. Of these, 5 patients underwent a second curettage and grafting procedure and 3 patients were lost to follow-up. Complete healing occurred in all the patients that underwent a second curettage and grafting procedure. CONCLUSION The achievement of complete healing in the patients that underwent a second curettage and grafting procedure indicates that the recurrence of UBC and ABC is associated with insufficient curettage.
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Affiliation(s)
- Suat Çelik
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Abuzer Uludağ
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Hacı Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Murat Gürger
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Fırat University, Elazığ, Turkey
| | - Sabahattin Kılıç
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Fırat University, Elazığ, Turkey
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Tosun HB, Gümüştaş SA, Kom M, Uludağ A, Serbest S, Eröksüz Y. The Effect of Sodium Hyaluronate plus Sodium Chondroitin Sulfate Solution on Peritendinous Adhesion and Tendon Healing: An Experimental Study. Balkan Med J 2016; 33:258-66. [PMID: 27308069 DOI: 10.5152/balkanmedj.2016.140172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 03/10/2014] [Accepted: 09/16/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adhesion formation following tendon injury is a serious clinical problem. AIMS In this experimental study, the effects of the combination of sodium hyaluronate (HA) and chondroitin sulfate (CS) on peritendinous adhesion and tendon healing were evaluated. STUDY DESIGN Animal experimentation. METHODS Twenty-one mature Sprague Dawley male rats were randomly divided into three equal groups. The rats' Achilles tendons were cut and repaired with a modified Kessler technique. About 0.25 and 0.50 mL of the HA and CS (HA+CS) combination were injected subcutaneously into the repair site of the rats in groups 1 and 2, respectively, on days 0, 3, 7, and 10. The subjects in group 3 were used as the control group. At 6 weeks, all rats were euthanized. The tenotomy site was examined macroscopically in all animal subjects. Four samples were assigned to the histopathological examination group, and the others were assigned to the biomechanical assessment group. RESULTS Inflammation and adhesion in both treatment groups were observed at a lower rate than in the control group. The collagen filaments in both treatment groups were regular and the number was low when compared to the control group. However, there was no statistically significant difference between group 1 and the control group. The quantity, quality, and grade of the adhesions were statistically significantly lower in group 2 when compared with the other groups. The mean maximum stress strength in group 2 was statistically significantly higher than that in group 1 and the control group. CONCLUSION Local administration of the HA+CS combination solution is a valid tool for preventing peritendinous adhesion after extrasynovial tendon repair such as Achilles tendon, and is a treatment option in such cases.
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Affiliation(s)
- Hacı Bayram Tosun
- Department of Orthopaedics and Traumatology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Seyit Ali Gümüştaş
- Department of Orthopaedics and Traumatology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Mustafa Kom
- Department of Surgery, Fırat University School of Veterinary Medicine, Elazığ, Turkey
| | - Abuzer Uludağ
- Department of Orthopaedics and Traumatology, Adıyaman University School of Medicine, Adıyaman, Turkey
| | - Sancar Serbest
- Department of Orthopaedic Surgery, İnegöl State Hospital, Bursa, Turkey
| | - Yesari Eröksüz
- Department of Pathology, Fırat University School of Veterinary Medicine, Elazığ, Turkey
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Tosun HB, Serbest S, Turk BA, Gumustas SA, Uludag A. Giant malignant peripheral nerve sheath tumor of thigh in an adolescent with neurofibromatosis type 1: a case report. Int Med Case Rep J 2015; 8:267-71. [PMID: 26604833 PMCID: PMC4630200 DOI: 10.2147/imcrj.s92015] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are rare sarcomas of children and adolescents, and they are aggressive tumors with a high rate of local recurrence. We present a 15-year-old boy with neurofibromatosis type 1 (NF1), who had a giant MPNST on the right thigh taking into account the available literature. Diagnosis of MPNST may be delayed in NF1 patients due to confusion with a neurofibroma and/or a plexiform neurofibroma. Malignancy should be considered, especially in cases with big masses, with heterogeneous involvement, or in the presence of cysts or necrotic nodules. The aim of surgical treatment is complete surgical excision.
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Affiliation(s)
- Hacı Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
| | - Sancar Serbest
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Bilge Aydın Turk
- Department of Pathology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
| | - Seyit Ali Gumustas
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
| | - Abuzer Uludag
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey
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Gümüştaş SA, Tosun HB, Ağır İ, Orak MM, Onay T, Okçu G. Influence of number and orientation of screws on stability in the internal fixation of unstable femoral neck fractures. Acta Orthop Traumatol Turc 2015; 48:673-8. [PMID: 25637733 DOI: 10.3944/aott.2014.14.0088] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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 The aim of this study was to biomechanically compare 3 different cannulated screw configurations used in internal fixation of unstable femoral neck fractures. METHODS The study included 28 synthetic left femurs randomly divided into 4 equal groups. Samples in the first 3 groups were osteotomized in the basicervical region to create Pauwels Type 3 fractures. Fixation was carried out using cannulated screws. In Group 1, four screws were used including 3 in an inverted triangle configuration in parallel with the neck and the fourth screw transversely into the calcar. In Group 2, three screws were used including 2 in parallel with the neck and the third transversely into the calcar. In Group 3, three screws were used in an inverted triangle configuration in parallel with the neck. No osteotomy or fixation was carried out in Group 4. Load test was performed on all the groups and the strength of the screw fixations against axial load and their amount of relocation were measured. RESULTS Average maximum strength was 36.1 ± 3.2 N/mm2 in Group 1, 27.3 ± 4.1 N/mm2 in Group 2 and 21.9 ± 3.2 N/mm2 in Group 3. The average relocation in the line of osteotomy in the moment of average maximum stress (21.9 ± 3.2 N/mm2) was 11.5 ± 2.1 mm in Group 3, 6 ± 1.3 mm in Group 2 and 5.8 ± 1.1 mm in Group 1 (p<0.05). It was also observed that while the relocation in the moment of average maximum stress (27.3 ± 4.1 N/mm2) was 9.1 ± 1.7 mm in Group 2, the deformation under the same stress value was 9 ± 1.7 mm in Group 1 (p>0.05). CONCLUSION The use of a transverse screw in the calcar in addition to cannulated screws parallel to the neck appear to provide stability benefit in the treatment of unstable femoral neck fractures.
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Affiliation(s)
- Seyit Ali Gümüştaş
- Department of Orthopedics and Traumatology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Hacı Bayram Tosun
- Department of Orthopedics and Traumatology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - İsmail Ağır
- Department of Orthopedics and Traumatology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Mehmet Müfit Orak
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Tolga Onay
- Department of Orthopedics and Traumatology, Marmara University Training and Research Hospital, İstanbul, Turkey
| | - Güvenir Okçu
- Department of Orthopedics and Traumatology, Hafsa Sultan Hospital, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
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Tosun HB, Uludağ A, Serbest S, Gümüştaş S, Erdoğdu IH. A rare case of extensive diffuse nonpigmented villonodular synovitis as a cause of total knee arthroplasty failure. Int J Surg Case Rep 2014; 5:419-23. [PMID: 24892248 PMCID: PMC4064475 DOI: 10.1016/j.ijscr.2014.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 11/08/2013] [Revised: 04/08/2014] [Accepted: 04/28/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Nonpigmented villonodular synovitis (non-PVNS) is a benign proliferative disease involving the synovium. It is a rare condition that is little recognized. Non-PVNS has been reported as a cause of total knee replacement failure. PRESENTATION OF CASE We report a case of extensive diffuse non-PVNS in a patient with tibial component loosening after total knee replacement and review the related literature. DISCUSSION It is reported that pigmented villonodular synovitis (PVNS) occurs less frequently than non-PVNS after knee replacement. However, there are many more case reports of PVNS than non-PVNS after knee arthroplasty in the English-language literature. CONCLUSION Previously, there were no reported cases of extensive diffuse non-PVNS after total knee arthroplasty (TKA). This case study highlights an unusual case of non-PVNS as a cause of TKA failure. We propose that non-PVNS should be considered as a differential diagnosis in patients after TKA who present with recurrent pain and effusion/hemarthrosis of the knee, and that it is one of the causes of implant loosening after TKA.
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Affiliation(s)
- Hacı Bayram Tosun
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey.
| | - Abuzer Uludağ
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - Sancar Serbest
- Department of Orthopaedic Surgery, Kırklareli State Hospital, Kırklareli, Turkey
| | - Seyitali Gümüştaş
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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