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    Comparison of soft-tissue and bone surgeries in the treatment of developmental dysplasia of the hip in 18-24-month-old patients
    (Lippincott Williams & Wilkins, 2013) Bulut, Mehmet; Karakurt, Lokman; Azboy, Ibrahim; Demirtas, Abdullah; Ersoz, Galip; Belhan, Oktay
    The aim of this study was to compare soft-tissue and bone surgeries in 18-24-month-old patients with developmental dysplasia of the hip (DDH). A total of 77 hips of 53 patients were analyzed. Soft-tissue surgery was performed in 31 hips of 25 patients. In the final examination, 23 hips, excluding hips of eight patients who underwent secondary bone surgery, were evaluated (group I). Bone surgery was performed on 46 hips of 28 patients (group II). In group I, the acetabular index was 41 degrees preoperatively and was 20.4 degrees in the final examinations. In group II, the acetabular index was 42 degrees preoperatively and was 15 degrees in the final examinations. To avoid unnecessary surgeries and complications, soft-tissue surgery should be preferred for DDH in 18-24-month-old patients.
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    Congenital Pseudoarthrosis of the Tibia: Case Reports
    (Derman Medical Publ, 2015) Bulut, Mehmet; Karakut, Lokman; Belhan, Oktay; Sagiroglu, Muhittin Soner; Gurger, Murat
    Congenital pseudoarthrosis of the tibia is rarely seen disease which is very difficult to treat. Congenital pseudoarthrosis of the tibia is frequently seen together with neurofibromatosis. Especially according to Boyd classification, type II and V are in the high risk group. In this study, we presented the treatment result of the three years old male patient with type V congenital pseudoarthrosis of the tibia.
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    Gelişimsel kalça displazisi taraması için yapılan kalça ultrasonografisi sonuçlarının değerlendirilmesi
    (2010) Bulut, Mehmet; Serbest, Sancar; Tosun, Haco Bayram; Karakurt, Lokman; Belhan, Oktay
    Amaç: Bu çalışmada 0-9 aylık bebeklerde gelişimsel kalça displazisi (GKD) sıklığını belirlemek amaçlandı.Gereç ve Yöntemler: Kliniğimize başvuran 0-9 aylık 310 bebeğin 620 kalçası, Graf yöntemi kullanılarak ultrasonografik olarak incelendi. Olgularımızın 137'si (%44.2) erkek, 173'ü (%55.8) kızdı. Fizik muayene bulguları ve risk faktörleri ile displazik ve desentre kalçalar arasında ilişkiler değerlendirildi. Yenidoğan döneminde klinik veya sonografik olarak GKD tanısı konulan hastalar 6 hafta sonra tekrar değerlendirildi.Bulgular: İnceleme sonucunda, Graf metoduna göre sınıflandırıldığında; 620 kalçanın incelemesinde %6.93 tip Ia, % 78.39 tip Ib, %9.52 tip IIa, % 0.32 tip IIb, %1.45 tip IIc, %0.81 tip D, %2.1 tip III ve %0.48 tip IV kalça saptandı. Çalışmamızda displazi sıklığı %14.7, desentre kalça sıklığı ise %3.4 olarak bulundu. Yenidoğan döneminde Graf tip II kalça tespit edilenlerin %92.7'i ebeveynleri tarafından kontrol muayenesine getirilmedi.Sonuç: Gelişimsel kalça displazisi bölgemizde hala önemli bir sağlık sorunu olmasına rağmen GKD'li hastaların ebeveynleri hastaların takip ve tedavisi için yeterli ilgiyi göstermemektedirler. Gelişimsel kalça displazisinin erken tanı ve takibinde ultrasonografi önemlidir. Gerçek displazi sıklığını belirlemek için fizyolojik gelişimin tamamlandığı ilk altı haftadan sonra kontrol ultrasonografisinin yapılması gerekir.
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    Lengthening by distraction osteogenesis in congenital shortening of metacarpals
    (Turkish Assoc Orthopaedics Traumatology, 2013) Bulut, Mehmet; Ucar, Bekir Yavuz; Azboy, Ibrahim; Belhan, Oktay; Yilmaz, Erhan; Karakurt, Lokman
    Objective: The aim of this study was to present the results of seven cases of metacarpal lengthening by distraction osteogenesis and to discuss the ideal daily rate of distraction. Methods: Metacarpal lengthening was performed by distraction osteogenesis in the seven metacarpals of four patients (3 females, 1 male; mean age: 14.9 years). A unilateral external fixator was used for lengthening. Lengthening was initiated with a distraction rate of 2x0.5 mm/day in the patient with bilateral. involvement of the middle and ring metacarpals. On the tenth day of lengthening, distraction was discontinued due to pain and contracture. Then, distraction was continued with a rate of 2x0.25 mm/day. In all other cases, the distraction rate was 0.5 mm/day. Pre- and postoperative range of motion was measured with a goniometer. Patient satisfaction was evaluated with visual analog scale. Results: The mean pre- and postoperative metacarpal lengths were 34.6 pun (range: 33 to 37) and 49.7 mm (range: 47 to 52), respectively. The mean lengthening achieved was 15.1 mm (range: 14 to 17), while the Mean distraction rate was 0.55 mm/day (range: 0.48 to 0.63). No functional loss was observed in the fingers at the final check-up. The patients were happy with the functional and cosmetic results. Conclusion: Distraction osteogenesis is a safe method providing acceptable cosmetic and functional results in patients with congenital metacarpal shortness. The length of metacarpals and muscles that will be affected from lengthening should be considered when determining the daily rate of distraction.
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    Management of developmental dysplasia of the hip in less than 24 months old children
    (Springer Heidelberg, 2013) Bulut, Mehmet; Gurger, Murat; Belhan, Oktay; Batur, Omer Cihan; Celik, Suat; Karakurt, Lokman
    Background: There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in children less than 24 months of age. Materials and Methods: Sixty hips of 50 patients (4 male, 46 female) with mean age of 14.62 +/- 5.88 (range 5-24 months) months with a mean followup of 40.00 +/- 6.22 (range 24-58 months) months were included. Twenty five right and 35 left hips (10 bilaterally involved) were operated. Open reduction was performed using the medial approach in patients aged < 20 months (with Tonnis type II-III and IV hip dysplasias) and for those aged 20-24 months with Tonnis type II and III hip dysplasias (n = 47). However for 13 patients aged 20-24 months with Tonnis type IV hip dysplasias, anterior bikini incision was used. Results: Mean acetabular index was 41.03 +/- 3.78 degrees (range 34 degrees-50 degrees) in the preoperative period and 22.98 +/- 3.01 degrees (range 15 degrees-32 degrees) at the final visits. Mean center-edge angle at the final visits was 22.85 +/- 3.35 degrees (18 degrees-32 degrees). Based on Severin radiological classification, 29 (48.3%) were type I (very good), 25 (41.7%) were type II (good) and 6 (10%) were type III (fair) hips. According to the McKay clinical classification, postoperatively the hips were evaluated as excellent (n = 42; 70%), good (n = 14; 23.3%) and fair (n = 4; 6.7%). Reduction of all hip dislocations was achieved. Additional pelvic osteotomies were performed in 14 (23.3%) hips for continued acetabular dysplasia and recurrent subluxation. (Salter [n = 12]/Pemberton [n = 2] osteotomy was performed). Avascular necrosis (AVN) developed in 7 (11.7%) hips. Conclusion: In DDH only soft-tissue procedures are not enough, because of the high rate of the secondary surgery and AVN for all cases aged less than 24 months. Bone procedures may be necessary in the walking age group with high acetabular index.
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    Ray amputation for the treatment of macrodactyly in the foot: report of three cases
    (Turkish Assoc Orthopaedics Traumatology, 2011) Bulut, Mehmet; Karakurt, Lokman; Belhan, Oktay; Serbest, Sancar
    Foot macrodactyly is a rare congenital anomaly which is characterized by an overgrowth of the soft tissue and bone of the toes. The aim of treatment is to obtain a cosmetic and functional foot. We present three cases of lesser toe macrodactyly on which we performed ray amputation. Postoperative cosmetic and functional results were good in three cases. Ray amputation is a possible surgical treatment that provides good cosmetic and functional results in severe lesser toe macrodactyly.
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    Uzun kemik yerleşimli osteoid osteomalı olgularda cerrahi tedavi sonuçları
    (2010) Bulut, Mehmet; Yıldırım, Hanifi; Tosun, H. Bayram; Serin, Erhan; Karakurt, Lokman; Yılmaz, Erhan; Belhan, Oktay
    Amaç: Uzun kemik yerleşimli osteoid osteomalı olgulara uygulanan farklı cerrahi tedavi sonuçlarının retrospektif olarak değerlendirilmesi.Gereç ve Yöntemler: Uzun kemik yerleşimli osteoid osteoma nedeniyle cerrahi tedavi yapılan10 hasta (5 erkek, 5 kadın; ortalama yaş 21; dağılım 13-35) retrospektif olarak değerlendirildi. Osteoid osteomalar 5 olguda femur cisim, 2 olguda tibia cisim, 1 olguda femur boyun ve 2 olguda ise humerus cisim yerleşimliydi. 6 olguda nonsteroid antiinflamatuar ilaçlara (NSAİİ) cevap veren gece ağrısı öyküsü mevcuttu. Cerrahi tedavide, en blok rezeksiyon, burr-down tekniği ile nidus tamamen çıkarıldı.Bulgular: Osteoid osteoma tanısıyla 5 olguya geniş en blok rezeksiyon, 5 olguya ise, burr-down tekniği ile nidus eksizyonu uygulandı. Cerrahi sırasında kemiğin zayıflatılması nedeniyle 3 olguda spongioz allogreft kullanılarak greftleme, 2 olguda ise patolojik kırık riski nedeniyle spongioz allogreft kullanılarak greftleme ile birlikte internal tespit yapıldı. Hiçbir olguda ameliyat sırasında ve sonrasında komplikasyonla karşılaşılmadı. Son kontrollerinde olgular tamamen asemptomatikti ve hiçbirinde nüks görülmedi.Sonuç: Osteoid osteoma tedavisinde, nidus yerinin ameliyat öncesi ve ameliyat sırasında tam olarak belirlenmesi ve nidusun tam olarak eksize edilmesi ile yeterli ve etkili sonuç elde edilebileceğini düşünmekteyiz.