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Öğe Can American Orthopaedic Foot and Ankle Society (AOFAS) score prevent unnecessary MRI in isolated ankle ligament injuries?(SAGE Publications Ltd, 2022) Kandemir, Veysel; Akar, Mehmet Sait; Yiğit, Şeyhmus; Durgut, Fatih; Atiç, Ramazan; Özkul, EminIntroduction and Objective: Ankle injuries are the most common musculoskeletal injuries. Its incidence is also high among sports injuries. Direct X-ray, ultrasound and MRI can be requested after the history and physical examination in the patient who presents with ankle ligament injury. Some classifications are used for requesting direct X-ray after ankle injury. Since clear limits are not specified in the literature for MRI, the rate of unnecessary MRI examinations is high. We argue that the decision can be made according to the AOFAS score to be checked before MR is requested, and thus unnecessary MR requests can be reduced. Material and Method: Ankle MRI images of patients who underwent ankle MRI due to ankle trauma between January 2018 and December 2020 were scanned. 328 patients who met the criteria were included in the study. Patients with AOFAS scores in their outpatient clinic records were identified. AOFAS scores of patients with at least one ligament injury and those with normal MR images were statistically compared. Sensitivity and specificity were determined for the AOFAS score using ROC analysis. Results: Patients with ligament damage as a result of MRI examination were 21.3% (n=70), and patients without any ligament damage were 78.7% (n=258). There was a statistically significant difference in terms of AOFAS between the group with ligament damage and the group without ligament damage (p< 0.05). In the ROC analysis, the AOFAS threshold value for MR request was determined as 80.5 (84.3% sensitivity and 72.3% specificity). Based on the determined threshold value, 73 patients who had unnecessary MRI would have been eliminated, thus reducing the number of MRIs by 42.6%. Conclusion: The AOFAS scores of patients with ligament damage were statistically significantly lower than those of patients without ligament pathology. Unnecessary MRI can be significantly prevented by using the AOFAS score in ankle traumas without bone fractures.Öğe Can formation of avascular necrosis really be prevented in Delbet type 2 femoral neck fractures?(Ulusal Travma ve Acil Cerrahi Derneği, 2022) Akar, Mehmet Sait; Yiğit, ŞeyhmusBACKGROUND: Fractures of proximal femur are rarely seen in childhood. These fractures can result in serious complications such as avascular necrosis (AVN), coxa vara, and early closure of the femoral epiphysis. The aim of this study is to investigate retrospectively the Delbet type 2 fractures that are commonly seen and has high rates of AVN. METHODS: Forty-two patients whose Delbet type 2 fractures were treated in our hospital between January 2009 and June 2018 were analyzed. The patients’ mechanism of fracture formation, displacement of the fracture, presence of accompanying injuries, tim- ing of surgery, open or closed reduction, whether the screws cross the epiphyseal growth plate epiphyseal line, and AVN data were analyzed retrospectively. RESULTS: Of the 42 screened patients, 34 patients with complete follow-up graphs and files were included in the study. The mean age of the patients was 11.02 years (1–17 years old), and the mean follow-up time was 40.82 months (range 24 to 98 months). When the follow-up radiographs of the patients were examined, it was found that AVN in 9 patients (26.5%), coxa vara in 2 patients (5.9%), and non-union in 1 patient (2.9%). The AVN rate was significantly higher in patients with high-energy injuries and high fracture dis- placement at baseline (p=0.034 and p=0.047, respectively). CONCLUSION: According to our findings in Delbet type 2 fractures, other than the severity of the trauma and the initial displace- ment of the fracture, factors related to the treatment process do not have a significant effect on the development of AVN. Age was not determined as a risk factor for the development of AVN in these patients.Öğe Comparison of complications and results of early vs. delayed surgery for pediatric supracondylar humeral fractures(Verduci Editore s.r.l, 2023) Ulus, Sait Anıl; Akar, Mehmet SaitOBJECTIVE: Pediatric supracondylar humerus fracture (SCHF) is one of the most common elbow fractures in children aged 5-7 years. There is a continuous discussion regarding the optimal timing for conducting surgery for fractures of this nature. Therefore, we aimed to determine whether the timing of surgery in pediatric SCHFs has an impact on the frequency of early postoperative complications. PATIENTS AND METHODS: Between January 2018 and March 2020, pediatric SCHF patients who underwent surgery at our hospital were retrospectively reviewed. Patients operated on within 12 hours after the fracture and those operated on later were respectively included in the early and late groups. Early postoperative complications, including neurological deficits, iatrogenic ulnar nerve injury, vascular injury, compartment syndrome, K-wire migration, and unexpected returns to the operating room, were compared between the two groups. We investigated surgical duration, reduction, and perioperative radiographic data. RESULTS: For modified Gartland type II or type III fractures, there was no significant difference in the incidence of early complications between the early and delayed groups. Additionally, there were no noticeable differences between the two groups in terms of perioperative radiographic data, reduction procedure, or surgical duration. CONCLUSIONS: Delayed surgery in type II or type III supracondylar humerus fractures was not associated with an increased incidence of early postoperative complications. The difficulty or effectiveness of reduction is not influenced by the timing of surgery.Öğe Determination of risk factors for instability in pediatric distal radius fractures(2023) Zhamilov, Vadym; Akar, Mehmet SaitAim: Distal radius fractures (DRF) are one of the most common injuries in childhood. DRF most commonly occurs as a result of low-energy falls onto an outstretched hand, resulting in axial loading of the metaphysodiaphyseal junction of skeletally immature long bones. One of the most common complications after the closed reduction and casting of displaced DRF is fracture relocation or loss of reduction. The aim of our study is to investigate the characteristics of these fractures by retrospectively scanning the patients who require surgical intervention in patients with distal radius fractures. Methods: Between January 2018 and January 2021, patients aged 1-16 years with a diagnosis of distal radius fracture who were treated in our hospital were included in this study. The preoperative X-rays of the patients were evaluated and the fractures were classified according to their displacement ratio. The reduction quality was rated according to the study of Alemdaroglu criteria. The distance of the fracture line to the joint line, the presence of ipsilateral ulna fracture, the angle of the fracture, and whether it was fragmented were determined. Patients with and without surgery were compared. Results: 206 patients who met the inclusion criteria were included in the study. A significant difference was found between the non-operated and operated groups in terms of age by Student's t-test (p=0.032). The distance from the fracture line of the surgical group to the joint line was measured to be 43.8 mm on average. A significant difference was found between the non-operated and operated groups in terms of the joint line distance of the fracture line by Student's t-test (p=0.010). There was a significant difference between the groups according to the Alemdaroğlu criteria and Mania criteria (p=0.001). Conclusions: Our results show that complete displacement of distal radius fracture and non-anatomical reduction are important risk factors for re-displacement and therefore emerge as surgical indications in pediatric patients. Our study also emphasizes that surgical treatment may be required in older pediatric patients when the ulna fracture coexistence and the joint distance of the fracture line increases.Öğe The effect of virtual rainforest and a white noise mobile application on satisfaction, tolerance, comfort, and vital signs during arthroscopy(Churchill Livingstone, 2024) Genç, Hasan; Tanrıverdi, Seher; Akar, Mehmet SaitBackground and purpose: This study was conducted to investigate the effect of Virtual Rainforest (VRF) and a White Noise (WN) mobile applications on patient satisfaction, tolerance, comfort, and vital signs during arthroscopic knee surgery. Methods: This is a randomized, controlled, interventional study. The study was completed with a total of 93 participants, 31 in the VRF group, 31 in the WN group, and 31 in the control group. Data were collected using a Patient Information Form and a Visual Analog Scale for satisfaction, tolerance, and comfort. Results: The results of study showed that there were significant increases in tolerance, satisfaction, comfort, respiratory rate, and oxygen saturation levels and significant decreases in heart rate, systolic and diastolic blood pressures in both VRF and WN groups (p < .05). In the control group, no significant difference was found between the means of the variables before and after the procedure (p > .05). Conclusion: According to the results of the study, VRF and WN applied during the arthroscopy procedure increased satisfaction, tolerance, and comfort in patients and had a positive effect on vital signs. Trial and protocol registration: ClinicalTrials.gov, NCT05992714.Öğe The Effects of Surgical Timing on Treatment Outcomes in Carpal Tunnel Syndrome(Galenos Publ House, 2022) Durgut, Fatih; Sahin, Erdem; Akar, Mehmet Sait; Ozdemir, Ali; Yigit, SeyhmusObjective: The purpose of this study is to assess and compare outcomes of two different timing surgery for moderately carpal tunnel syndrome (CTS).Methods: Eighty-eight patients who underwent early and late due to CTS were evaluated retrospectively. Patients with early surgery and late surgery were divided into two groups. Preoperative and postoperative visual analog scale (VAS) score and postoperative Boston Carpal Tunnel Questionnaire (BCTQ) scores of both groups were compared.Results: Preoperative and postoperative VAS scores were compared, there was a significant decrease in both groups. When BCTQ results of both groups were compared, the results of patients who underwent early surgery were statistically better.Conclusion: In conclusion, we think that early surgery is better clinically in patients with moderately CTS.Öğe Epidemiological investigation and ultrasonographic results of developmental dysplasia of the hip in infants aged 0-6 months(2023) Akar, Mehmet Sait; Ulus, Sait AnilAim: To determine the prevalence of developmental dysplasia of the hip (DDH), a common condition in our region, and investigate the underlying factors contributing to its occurrence. Methods: A total of 715 hips from 370 newborns were evaluated using ultrasonography. The patients' gender, alpha, and beta angles, affected hip, and Graf classification types were noted. Risk factors were compared between the groups. Patients diagnosed with DDH were treated with the Pavlik harness. Results: In the initial evaluation, 61 out of 370 patients (16%) were diagnosed with Graf type 2c, 3, or 4 hips. 48 patients were female, and 13 patients were male. Patients who were female (20.1%) had a statistically significant greater incidence of DDH than patients who were male (9.8%) (p<0.05). In terms of statistical significance, there was no difference between DDH incidence in the right hip and left hip (p>0.05). The application of swaddling was more frequent in the group with diagnosed DDH compared to the normal group (p<0,05). Pavlik treatment was applied to 41 hips. After the treatment, 30 hips converted to type 1 hips. Six hips remained as type 2b, three hips progressed to type 2c, and one hip progressed to type 3. Conclusions: DDH continues to be a widespread concern. The incidence in our region is higher compared to other areas. Enhancing screening initiatives, pinpointing key risk factors, and bolstering family education are imperative steps towards its prevention.Öğe Evaluation of surgical or conservative treatment of forearm fracture in pediatric floating elbow injuries(Verduci Editore s.r.l, 2024) Ulus, Sait Anıl; Atiç, Ramazan; Yiǧit, Şeyhmus; Akar, Mehmet Sait; Dönmez, S.; Özkul, EminOBJECTIVE: Floating elbow, which refers to a humerus fracture in the supracondylar region and a forearm fracture, is a very unusual injury. The purpose of this study is to compare the clinical results of patients with “floating elbows” who underwent surgical therapy and who were given forearm immobilization with a splint as follow-up care. PATIENTS AND METHODS: Fifteen patients who had been diagnosed with floating elbow owing to trauma were scanned retrospectively and followed up for at least a year. Eight individuals who suffered from broken forearms underwent surgical repair. After initial treatment, a lengthy arm splint was used to immobilize seven patients’ arms. The modified Flynn criteria were used to analyze the data, and comparisons were made between the groups. RESULTS: The median age and mean follow-up time for patients whose forearms were conservatively followed was 6.1 years and 13.8 months, respectively. The median age of the patients who underwent forearm surgery was 8.5 years, and the average follow-up was 14.2 months. Five of the seven patients whose forearms underwent conservative follow-up had outstanding clinical outcomes, while two had poor and moderate outcomes. Four individuals who got surgical treatment for their forearms had excellent and good clinical outcomes, while the other four had intermediate and poor outcomes. Between the two groups, there was no discernible difference (p = 0.60). CONCLUSIONS: In the pediatric population with floating elbow injuries, using a cast for forearm fractures may not necessarily result in worse outcomes compared to surgical management.Öğe How successful is synthetic graft treatment for children with pathological hip fractures?(Sage Publications Ltd, 2023) Elci, Serhat; Ozkul, Emin; Alemdar, Celil; Atic, Ramazan; Akar, Mehmet SaitPurpose: To determine whether synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children. Methods: Paediatric patients treated for pathological fractures of the proximal femur between 2013 and 2020 were evaluated retrospectively. 17 patients with a mean age of 10.7 years (range 6-16 years) were assessed. The definitive histopathological diagnoses were SBC (simple bone cyst) (12) and ABC (aneurysmal bone cyst) (5). The median duration of follow-up was 37 months (range 12-70 months). Results: All patients returned to their normal daily routine within 3-8 months following surgery. The mean post-op recovery time was 3.2 months (range 3-6 months). Graft was incorporated at approximately 12 months. No significant radiographic healing was observed in 2 patients. In the remaining 15 patients, the mean duration of healing was 14 months (range 8-24 months). Conclusion: Synthetic grafts are a satisfactory treatment option for pathological proximal femoral fractures in children.Öğe Periprosthetic infection risks and predictive value of c-reactive protein / albumin ratio for total joint arthroplasty(Mattioli 1885, 2021) Yiğit, Şeyhmus; Akar, Mehmet Sait; Şahin, Mehmet Akif; Arslan, HüseyinBackground and aim: There are no gold standard markers to estimate the risk of developing periprosthetic infections. Our aim is to compare the risks of periprosthetic infection in patients with THA and THA and to investigate the predictive significance of the CRP / albumin ratio. Methods: This is a retrospective study containing data from 241 osteoarthritis patients and 19 patients with periprosthetic infections who underwent TKA and THA in our hospital from January 2014 to January 2019.12 risk factors(CRP/ albumin, albumin, CRP, age, gender, BMI, DM, ASA, nasal culture, urine culture, hospital stay, operation time) were analyzed. Results: In the binary logistic regression model and multivariate regression analysis, the rate of CRP / albumin was 17.161 times higher than the patients with ?0.16 cut-off value. (CRP / albumin ratio (odds ratio (OR) = 17.16, 95% CI: 1.55-189.03, P: 0.02). High BMI increased the risk of periprosthetic infection 1.3 times. Nasal bacterial colonization (OR = 0.99, 95% CI: 0.868-1.38, P: 0.7) and bacterium in urine (OR = 0.502, 95% CI: 0.07-3.598, P: 0.703) did not pose a significant risk for periprosthetic infection. Conclusion: According to our findings, the CRP / albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. CRP / albumin ratio is a cheap and easy to apply marker. Routine urine and nasal bacteria screening is not required before total joint arthroplasty.Öğe Periprosthetic infection risks and predictive value of HbA1c/albumin ratio for total joint arthroplasty in patients with diabetes mellitus(Verduci Editore s.r.l, 2023) Yiğit, Şeyhmus; Akar, Mehmet SaitOBJECTIVE: There are no gold standard markers to estimate the risk of developing periprosthetic infections in diabetes mellitus. Our aim is to compare the risks of periprosthetic infection in patients undergoing total joint arthroplasty with diabetes mellitus and to investigate the predictive significance of the HbA1c/ albumin ratio. PATIENTS AND METHODS: Between January 2012 and January 2020, 690 patients who underwent total joint arthroplasty were analysed. 264 diabetic patients were included in the study. 104 of them had periprosthetic infection. 8 risk factors (Hba1c/albumin, HbA1c, albumin, age, BMI, ASA, hospital stay, operation time) were analysed. RESULTS: The rate of HbA1c/albumin was 14.6 times higher than the patients with ≤2.37 cut-off value. (Hba1c/albumin ratio (odds ratio (OR) = 14.6, 95% CI: 3.18-67.1, p: 0.01). HbA1c (OR = 2.6, 95% CI: 1.529-4.754, p: 0.001), BMI (OR = 1.6, 95% CI: 1.168-2.199, p<0.003), DM (OR = 0.365, 95% CI: 0.135-0.987, p: 0.04) and glucose (OR = 1.016, 95% CI: 1.004-1.029, p: 0.011) were risk factures for periprosthetic infection. Albumin (OR = 0.503, 95% CI: 0.109-2.314, p: 0.378) did not pose a significant risk for periprosthetic infection. CONCLUSIONS: According to our findings, the HbA1c/albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. HbA1c/albumin ratio is a cheap and easyto-apply marker. Patients with an HbA1c/albumin cut-off ratio above 2.37 mg/dl in total joint arthroplasty should be followed more closely for the risk of periprosthetic infection.Öğe Predictive factors for the development of Gartland type IV supracondylar humerus fractures: a prospective clinical study(Aves Yayıncılık, 2022) Yiğit, Şeyhmus; Aslan, Rıdvan; Arslan, Hüseyin; Özkul, Emin; Atiç, Ramazan; Akar, Mehmet SaitObjective: This study aimed to identify the preoperative predictive factors for the development of Gartland type IV supracondylar humerus fracture based on the patient characteristic, fracture mechanism, and preoperative radiographic fracture characteristics. Methods: This prospective study included the data of 120 patients with Gartland type III and IV supracondylar humerus fractures treated in a single center from 2020 to 2021. Patients’ age, gender, height/weight percentile values, injury mechanisms, the proximity of fracture fragment to the skin (i.e., dimple sign), and time from trauma to surgical treatment were recorded. In the preoperative radiographs, the degree of extension or flexion deformity between fracture fragments in the sagittal plane, varus/valgus angulation between fracture fragments in the coronal plane, the amount of translation (medial or lateral) in the coronal plane, and the amount of osseous apposition between fracture fragments in the coronal plane were evaluated. With the authors’ consensus, the patients were divided into 2 groups based on the presence of multidirectional instability during the intraoperative reduction: group 1 (Gartland type III; 99 patients) and group 2 (Gartland type IV; 21 patients). Fixation of the fractures was then completed. Results: Significant differences were observed between groups in the valgus/varus angle and amount of osseous apposition (P < .001). Although no significant difference was found in terms of translation amount between the groups (P=.088), there was a significant correlation with medial translation in type IV fractures (P < .001). The correlation between the results and the groups was checked with Spearman’s test. Medial translation (r=0.352), varus or valgus angulation (r=0.616), and osseous apposition (r=0.433) exhibited a positive correlation. The probability of type IV fracture was modeled for the preoperative parameters using binary logistic regression. The regression analysis showed that the diagnosis of type IV supracondylar fractures could be predicted, if varus or valgus angulation was more than 25.5° (81% sensitivity, 85% specificity, odds ratio=1.725; 95% CI=1.170-2.541, P=.001, r=0.616) and if the amount of osseous apposition was more than 9.5 mm (85% sensitivity, 81% specificity, odds ratio=1.471; 95% CI=0.714-3.029, P=.001, r=0.433) in the preoperative radiographs. There was also a significant correlation between medial translation (varus angulation) (P < .001, r=0.352), age (P=.019, r=0.255), and patients with more than 90 height/weight percentile values (P < .001, r=0.508) with the possibility to have Gartland type IV fractures. Conclusion: This study has found some preoperative factors that may be relevant for type IV Gartland fractures. Height/weight values greater than the 90 percentile, varus or valgus angulation greater than 25.5°, bone apposition values greater than 9.5mm, medial translation values greater than 11mm, and older than eight years patients type IV fractures were more common in such patients. If surgeons can more accurately diagnose a Gartland type IV fracture preoperatively, the surgeon can more accurately inform the patient and plan better treatment.Öğe Surgical treatment results of fibrous dysplasia and effects of using grafts(Aves, 2021) Akar, Mehmet Sait; Yiğit, ŞeyhmusBACKGROUND/AIMS Fibrous dysplasia (FD) is a skeletal system disorder characterized by replacement of normal bone and bone marrow with fibro-osseous tissue and proliferation of immature osteogenic cells. There is no consensus regarding the timing of orthopedic surgery, the choice of implants, and use of grafts owing to its variable clinical appearance and wider age range. This study aimed to contribute to the literature by performing a retrospective study involving patients with FD. MATERIAL and METHODS This retrospective study included 41 patients with FD. Patients were evaluated for the first-visit and follow-up graphs. Patients were examined for the effects of intramedullary nailing and plate fixation. The use of grafts during surgery was noted and examined in terms of increase in deformity during the operation time and follow-up. RESULTS Surgical intervention was performed on 45 bone lesions in 41 patients. Plate was used in 7 patients with pathological fracture, and intramedullary nail was used in 19 patients. There was a significant difference between the groups (P=.011). No deformity was detected in 16 of the 26 patients with pathological fractures. In 20 patients in whom grafts were used, cortical thickening was observed on the basis of the preoperative graphs. Graft survival rate was reported to be 83.3%. CONCLUSION The presence of pathological fractures affects the choice of implants by surgeons. Cortical thinning is the most important parameter than deformity in terms of the risk assessment of pathological fractures for surgical planning. Allograft survival rate is high for 4 years, on average. Cite this article as: Akar MS, Yiğit Ş. Surgical Treatment Results of Fibrous Dysplasia and Effects of Using Grafts. Cyprus J Med Sci 2020; 6(1): 34-8.Öğe A technical trick for extracting a stingray spine from hand: a case report(Türk Ortopedi ve Travmatoloji Derneği, 2022) Akar, Mehmet Sait; Ulus, Sait Anıl; Durgut, Fatih; Yiğit, ŞeyhmusInjuries from stingray fish are among the most common fish stings, and their frequency is increasing with the increase in global tourism. It most commonly causes injuries to the extremities and causes morbidity if not treated appropriately. Less commonly, life-threatening injuries can be observed due to injuries in the thorax and abdomen and damage to large vessels and vital organs. In addition to severe pain, tissue necrosis, and secondary infection after injury, systemic symptoms may occur. Since these injuries can occur in both fresh and salt water, it is possible to encounter such a case at any time. Flat spines are sharp, with backward barbs or serrations that make them difficult to extract once they penetrate tissue. After first aid, surgical extraction of the stingray spine with minimal damage is essential in addition to local and systemic treatments. In the literature, there are studies on envenomation and other systemic findings after stingray spine injuries, but few publications are available on the stingray spine extracted technique after injury. This case report presents a new and helpful technique for stingray spine extraction.
