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Öğe Biomechanical properties of osteoporotic rat femurs after different hormonal treatments: genistein, estradiol, and estradiol/progesterone(Edp Sciences S A, 2016) Azboy, Ibrahim; Ozkaya, Mustafa; Demir, Teyfik; Demirtas, Abdullah; Arslan, Arslan Kagan; Ozkul, Emin; Akcan, AdnanIntroduction: The purpose of the study is to compare the effects of genistein, estradiol, estradiol/progesterone combination on the bone mineral density and biomechanical properties of ovariectomized rats' bone. Methods: 50 female adult Sprague-Dawley rats were divided into five groups. Bilateral ovaeriectomy were performed in all groups except the sham-operated group. Groups were a sham-operated group and a control group (water was given), estradiol treated group (17-b estradiol 0.015 mg/kg per day), genistein treated group (genistein 10 mg/kg per day), and an estradiol/progesterone combination group (17-b estradiol 0.015 mg/kg plus drosperinone 0.028 mg/kg per day). The water or hormones were implemented in relevant groups for eight weeks by orogasthric catheter. The bone mineral density and biomechanical properties of the femur were analyzed. Results: Genistein, estradiol, and estradiol/progesterone groups increased bone mineral density significantly compared to the control group. In diaphysis and metaphysis bending test, all groups had higher peak load values than the control group. There were statistically significant differences between the estrogen/progesterone group and control group in diaphysis bending with regard to peak load. There were statistically significant differences between the estradiol and control groups in metaphysis bending with regard to peak load. In axial rotation test, all groups had higher peak torque values than the control groups. Conclusions: Genistein, estradiol and estrogen/progesterone combination improved the biomechanical properties of the ovariectomized rat bone. Genistein which has less side effects may be considered as an alternative in the treatment of postmenopausal osteoporosis.Öğe The changes in preferences for venous thromboembolism prophylaxis after total joint arthroplasty in Turkey: A survey(Turkish Joint Diseases Foundation, 2018) Azboy, Nesrullah; Cimen, Cgouzhan; Demirtas, Abdullah; Elci, Serhat; Azboy, IbrahimObjectives: This study aims to investigate the changes in preferences of orthopedic surgeons for venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and the factors that affect such changes in Turkey. Materials and methods: Turkish Orthopedics and Traumatology Association members (n=2.180) were invited to fill in the questionnaire. A total of 366 orthopedic surgeons responded and completed questionnaire. The questionnaire was comprised of 12 questions investigating the demographics of surgeons. their preferences for VTE prophylaxis. the changes in their preferences over the course of the past three years. and the causes of such changes. Results: In the past three years, 31.1% of surgeons changed their VTE prophylaxis method and 32.7% used risk classifications. The use of low molecular weight heparin (LMWH) decreased from 89.4% to 42.5% and from 85.8% to 44.2% after TKA and THA. respectively. The use of aspirin increased from 10.6% to 43.4% and from 9.7% to 37.2% after TKA and TIIA, respectively. The use of oral anticoagulants increased from 11.5% to 41.6% and from 10.6% to 39.8% after TKA and THA, respectively. Still, orthopedic surgeons in Turkey preferred LN1W11 at rates of 75.7% and 74% after TKA and Tim. respectively. Congressional presentations were the first (47.7%) among the causes of the changes in preferences for VTE prophylaxis. Preferences of up to 60% of surgeons working at universities were influenced by the American Academy of Orthopedic Surgeons guidelines. Conclusion: In the past three years, approximately one third of orthopedic surgeons changed their preferences for VTE prophylaxis after total joint arthroplasty in Turkey. Changes in preferences were largely in favor of aspirin and oral anticoagulants in parallel to changes in guidelines for VTE prevention.Öğe A comparison of proximal femoral locking plate versus 95-degree angled blade plate in the treatment of reverse intertrochanteric fractures(Turkish Joint Diseases Foundation, 2014) Azboy, Ibrahim; Demirtas, Abdullah; Gem, Mehmet; Cakir, Idris Ahmet; Tutak, YilmazObjectives: This study aims to compare the results of the proximal femoral locking plate (PFLP) and the 95-angled blade plate in the treatment of AO/OTA 31-A3 reverse intertrochanteric fractures with fracture line extending to the greater trochanter. Patients and methods: Forty-four patients with reverse intertrochanteric fracture which fracture line extending to the greater trochanter were retrospectively analyzed. Of those, 20 were treated with PFLP (PFLP group) and 24 were treated with ABP (ABP group). The AO/OTA classification was used for the classification of the fractures. Patients were assessed clinically and radiologically for the union at the fracture site and implant-related complications. Hip functions were evaluated with the Harris hip score. Results: The mean time to union was 17 weeks (range 14-28) and 18 weeks (range 16-32) in the PFLP group and ABP group, respectively. Implant failure and/or nonunion was observed in two patients (10%) in the PFLP group and in three patients (12%) in the ABP group. There was no statistically significant difference between the groups with regard to the Harris hip scores, time to union, need for reoperation due to mechanical problems, and complication rates (p > 0.05). Conclusion: Our study results show that these two fixation methods seem to produce similar results in the treatment of reverse intertrochanteric fractures with greater trochanteric comminution. However, we suggest that ABP still remains as a good choice with less expense in such fractures.Öğe Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur(Turkish Assoc Orthopaedics Traumatology, 2014) Demirtas, Abdullah; Azboy, Ibrahim; Ozkul, Emin; Gem, Mehmet; Alemdar, CelilObjective: The aim of this study was to compare retrograde intramedullary nailing (RIMN) and bridge plating for the treatment of extra-articular distal femur fractures. Methods: The study retrospectively examined 15 patients (13 males and 2 females; mean age: 36 years, range: 17 to 55 years) who underwent bridge plating and 13 patients (11 males and 2 females; mean age: 31.1 years, range: 17 to 49 years) who underwent RIMN for the treatment of extra-articular distal femur fractures between 2007 and 2012. Functional results were evaluated using the Sanders criteria. The mean follow-up time was 31.3 (range: 20 to 46) months and 26.7 (range: 18 to 62) months in the plate and the nail groups, respectively. Results: Mean duration until union was 25.7 (range: 12 to 72) weeks in the plate group and 22.3 (range: 12 to 52) weeks in the nail group. Nonunion was observed in 2 patients in the plate group and in 1 in the nail group, delayed union in 3 patients in the plate and 2 in the nail groups, malalignment (>10 degrees) in 2 patients in the plate group and 1 in the nail group and implant failure in 1 patient in the plate group. Excellent/good functional results were obtained in 12 and 10 patients in the plate and the nail groups, respectively. No significant difference was found between the groups in terms of duration of union, complications and functional results (p>0.05). Conclusion: Bridge plating and RIMN have similar results in the treatment of extra-articular distal femur fractures. Both methods can be applied to all fractures, with the exception of Gustilo-Anderson Type 3B and C open fractures.Öğe 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, OktayThe 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.Öğe A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up(Springer, 2014) Azboy, Ibrahim; Demirtas, Abdullah; Gem, Mehmet; Kiran, Seymuz; Alemdar, Celil; Bulut, MehmetThe purpose of this study was to compare clinical and radiological outcomes of patients who underwent single-bundle anterior cruciate ligament (ACL) reconstruction with anteromedial portal (AMP) and transtibial (TT) techniques. Arthroscopic single-bundle ACL reconstruction was performed using AMP technique in 34 patients and TT technique in 30 patients. The patients were evaluated retrospectively. Aperture fixation was used for femoral fixation, and absorbable screws and U staples were used for tibial fixation of the graft. Pivot shift test, Lachman test, Lysholm, Tegner, and International Knee Documentation Committee (IKDC-2000) scoring systems were used in the clinical and functional evaluation of patients before and after the surgery. Time to return sports and activity level were assessed. In the radiological evaluation of non-anatomic bone tunnel placement, the criteria developed by lllingworth et al. were used. The mean duration of follow-up was 20.4 and 24.6 months in the AMP and TT groups, respectively. There was a significant difference between the AMP group (86.7 %) and the TT (14.7 %) group in terms of anatomical placement of the femoral tunnels and grafts (p < 0.001). No significant difference was observed between the two groups in terms of the Pivot shift test, Lachman test, Lysholm, Tegner, and IKDC scores, and activity level (p > 0.05). The patients in the AMP group returned to sports 1.5 months earlier on average (p < 0.001). It was shown that AMP technique was superior to the TT technique in providing anatomical placement of the graft and in recovery time to return sports; however, there was no difference between groups in early periods in terms of the clinical and functional outcomes.Öğe The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus(Turkish Assoc Trauma Emergency Surgery, 2016) Azboy, Ibrahim; Bulut, Mehmet; Ancar, Cahit; Demirtas, Abdullah; Ozkul, Emin; Gem, Mehmet; Karadeniz, HilmiBACKGROUND: This study aimed to evaluate the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy. METHODS: Forty patients with intra-articular distal humerus fractures were retrospectively analyzed. TRAP approach was used in 22 patients (12 males, 10 females; mean age 37.8 years, range 17-70), and olecranon osteotomy in 18 patients (11 males, 7 females; mean age 35.4 years, range 18-62). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. RESULTS: The overall mean arc of elbow motion was 108 degrees (range 70 degrees-140 degrees) in the TRAP group, whereas that of the olecranon osteotomy group was 98 degrees (range 70 degrees-115 degrees). A significant difference was observed between the two groups in terms of overall mean arc of elbow motion (p=0.038). There were no significant differences noted between the two groups in terms of mean MEPS and DASH scores (p=0.412, p=201, respectively). The overall complication rate was 27.2% in the TRAP group and 55% in the olecranon osteotomy group. CONCLUSION: TRAP is a succesful approach in the treatmet of intra-articular distal humerus fractures that provides better arc of elbow motion, reduces complications and reoperation rates.Öğe The effect of hyperbaric oxygen therapy on fracture healing in nicotinized rats(Turkish Assoc Trauma Emergency Surgery, 2014) Demirtas, Abdullah; Azboy, Ibrahim; Bulut, Mehmet; Ucar, Bekir Yavuz; Alemdar, Celil; Alabalik, Ulas; Akpolat, VeysiBACKGROUND: The aim of the present study was to investigate the effect of hyperbaric oxygen therapy on fracture healing in nicotinized rats. METHODS: Thirty-two rats were divided as follows: nicotinized group (1), hyperbaric oxygen group (2), nicotinized + hyperbaric oxygen group (3), and control group (4). For 28 days, nicotine was administered in Groups 1 and 3. Then, a standard shaft fracture was induced in the left femur of rats. Groups 2 and 3 underwent hyperbaric oxygen therapy for 21 days. At the end of the experiment, fracture site, left femur and whole body bone mineral content and density were measured. RESULTS: The radiological and histopathological scores of Group 1 were statistically significantly lower compared to Groups 2, 3 and 4, and there was no statistically significant difference between the Groups 2, 3 and 4. In a comparison between the groups, no statistically significant difference was found in terms of bone mineral content and density values measured at the fracture site, left femur and whole body. CONCLUSION: The negative effects of nicotine on fracture healing are eliminated with hyperbaric oxygen therapy, but hyperbaric oxygen alone does not cause significant changes in healing (radiologically and histopathologically).Öğe Effectiveness of Locking Versus Dynamic Compression Plates for Diaphyseal Forearm Fractures(Slack Inc, 2013) Azboy, Ibrahim; Demirtas, Abdullah; Ucar, Bekir Yavuz; Bulut, Mehmet; Alemdar, Celil; Ozkul, EminThis study compares the results of the locking compression plate (LCP) and the dynamic compression plate (DCP) in the treatment of diaphyseal forearm fractures in adults and defines the indications for the use of the LCP. Forty-two patients with diaphyseal forearm fractures were retrospectively analyzed. Of those, 22 had been treated with the LCP (LCP group) and 20 had been treated with the DCP (DCP group). The AO/ASIF classification was used to classify the fractures. Patients were assessed using the Grace-Eversmann criteria and the Disabilities of the Arm and Shoulder and Hand questionnaire during the final follow-up. Mean follow-up was 21 months (range, 20-24 months) in the LCP group and 23 months (range, 19-26 months) in the DCP group. Union was achieved in all patients. Mean time to union was 15 weeks (range, 12-25 weeks) in the LCP group and 17 weeks (range, 13-24 weeks) in the DCP group. In each group, 1 patient experienced delayed union, which required no additional surgical intervention. No significant difference was found regarding the time to union between the groups (P>.05). No significant difference existed between the 2 groups in terms of Grace-Eversmann criteria and Disabilities of the Arm and Shoulder and Hand scores (both P>.05). The results of these different fixation methods for forearm fractures in adults are similar. As such, the correct selection and application of surgical technique is more important than the type of plate used.Öğe Effects of enoxaparin and rivaroxaban on tissue survival in skin degloving injury: an experimental study(Turkish Assoc Orthopaedics Traumatology, 2014) Azboy, Ibrahim; Demirtas, Abdullah; Bulut, Mehmet; Alabalik, Ulas; Ucar, Yavuz; Alemdar, CelilObjective: The aim of this study was to evaluate the effects of the antithrombotic agents enoxaparin, and rivaroxaban on tissue survival following skin degloving injury in an experimental rat tail model. Methods: The study included 24 rats divided into three equal groups of 8; the enoxaparin group (Group 1), the rivaroxaban group (Group 2) and the saline control group (Group 3). A degloving injury was created by making a circular incision 5 cm distal to the base of the tail; manual traction was applied to the tail skin distal to the incision. After 15 minutes, the ends of the incision were sutured back in place. Antithrombotic agents were administered immediately after suturing and repeated once a day for 15 days. At the end of Day 15, the experiment was terminated. Gross morphological tissue survival and histopathology were evaluated. Results: Histopathological examination of the enoxaparin and rivaroxaban groups revealed that the skin was mostly normal or intact with minimal inflammation. The mean length of necrotic area was significantly higher in the saline group compared to the enoxaparin and rivaroxaban groups (p < 0.05). No statistically significant differences were noted between the rivaroxaban and enoxaparin groups (p=0.451). The mean extent of skin necrosis was significantly higher in the control group than the study groups (p < 0.05), while there was no significant difference in the length of necrotic area between Group 1 and 2 (p=0.722). Conclusion: Rivaroxaban and enoxaparin improved tissue survival in skin degloving injuries in terms of gross morphological and histopathological findings in a rat tail model.Öğe Internet and social media usage of orthopaedic patients: A questionnaire-based survey(Baishideng Publishing Group Inc, 2017) Duymus, Tahir Mutlu; Karadeniz, Hilmi; Cacan, Mehmet Akif; Komur, Baran; Demirtas, Abdullah; Zehir, Sinan; Azboy, IbrahimAIM To evaluate social media usage of orthopaedic patients to search for solutions to their health problems. METHODS The study data were collected using face-to-face questionnaire with randomly selected 1890 patients aged over 18 years who had been admitted to the orthopaedic clinics in different cities and provinces across Turkey. The questionnaire consists of a total of 16 questions pertaining to internet and social media usage and demographics of patients, patients' choice of institution for treatment, patient complaints on admission, online hospital and physician ratings, communication between the patient and the physician and its effects. RESULTS It was found that 34.2% (n = 647) of the participants consulted with an orthopaedist using the internet and 48.7% (n = 315) of them preferred websites that allow users to ask questions to a physician. Of all question-askers, 48.5% (n = 314) reported having found the answers helpful. Based on the educational level of the participants, there was a highly significant difference between the rates of asking questions to an orthopaedist using the internet (P = 0.001). The rate of question-asking was significantly lower in patients with an elementary education than that in those with secondary, high school and undergraduate education (P = 0.001) The rate of reporting that the answers given was helpful was significantly higher in participants with an undergraduate degree compared to those who were illiterate, those with primary, elementary or high school education (P = 0.001). It was also found that the usage of the internet for health problems was higher among managers-qualified participants than unemployed-housewives, officers, workers-intermediate staff (P < 0.05). CONCLUSION We concluded that patients have been increasingly using the internet and social media to select a specific physician or to seek solution to their health problems in an effective way. Even though the internet and social media offer beneficial effects for physicians or patients, there is still much obscurity regarding their harms and further studies are warranted for necessary arrangements to be made.Öğe Intramedullary Titanium Elastic Nailing in the Treatment of Paediatric Diaphyseal Femur Fractures(Aves, 2013) Sukur, Erhan; Azboy, Ibrahim; Demirtas, Abdullah; Bulut, Mehmet; Ucar, Bekir Yavuz; Alemdar, CelilObjective: We evaluated the clinical and radiographical outcomes in paediatric patients with diaphyseal femur fractures who were treated with intramedullary titanium elastic nails. Methods: Twenty-two patients (15 boys, 7 girls; mean age 7.6 years; range 6 to 12 years) with diaphyseal femur fractures who were treated with retrograde titanium elastic nailing (TEN) were evaluated in the study. 15 of the fractures were located mid-diaphyseally, 4 proximal diaphyseally and 3 distal diaphyseally. Open reduction via lateral incision was applied in cases in which closed reduction could not be achieved. Anterior-posterior and lateral radiographical views of the femur were used in the follow-up period. Gait patterns, range of motion of the knees and the hips, hospitalization time, time to union, limb length discrepancy between the lower extremities, and any complications were evaluated in the patients. Flynn's TEN scoring system was used to evaluate the outcomes. Results: Union was obtained in a mean of 6.8 weeks (range 5 to 11 weeks) in all of the patients. The anterior-posterior radiographs indicated that normal alignment was achieved in 19 patients. Two patients had a 5 degree varus malalignment and one had a 6 degree valgus malalignment. Two patients had a 6 degree anterior malalignment in the lateral radiographical view. Average limb length discrepancies of 7 mm were seen in 2 patients and of 6 mm were seen in 3 patients. Hip and knee motion were mildly restricted in one patient. Gait pattern was symmetric in all but one patient. Superficial wound infection was detected in one patient. None of the patients had nonunion, early closure of the epiphyseal plate or fracture following TEN extraction. Fifteen patients had excellent and 7 had good results according to Flynn's criteria. Mean hospitalization time was 4.2 days (range 3 to 9 days) and mean follow up period was 20.2 months (range 14 to 24 months). Conclusion: Intramedullary TEN is a successful method that yields good results for paediatric diaphyseal femoral fractures.Öğe Long-term results of porous-coated cementless total knee arthroplasty with screw fixation(Turkish Assoc Orthopaedics Traumatology, 2013) Azboy, Ibrahim; Demirtas, Abdullah; Bulut, Mehmet; Ozturkmen, Yusuf; Sukur, Erhan; Caniklioglu, MustafaObjective: The aim of this study was to evaluate the long-term results of porous-coated, cementless total knee arthroplasty with screw fixation. Methods: This study included 68 knees of 54 patients (43 female, 11 male; mean age: 56.9 years, range 46 to 70 years). Cruciate-retaining cementless total knee prostheses were implanted in all patients diagnosed with primary osteoarthritis. Clinical, functional and radiological evaluations were performed according to the Knee Society's Knee Scoring System (KSS). Prosthesis survival was analyzed using Kaplan-Meier curves. Mean follow-up time was 9.2 (range: 8 to 12) years. Results: Preoperative mean knee and function scores were 42.3 (range: 32 to 61) and 39.1 (range: 35 to 66), respectively, while they were 88.6 (range: 54 to 96) and 82.8 (range: 50 to 100), respectively at the final follow-up (p<0.05). Mean preoperative knee flexion was 98 degrees (range: 80 degrees to 110 degrees) and 112 degrees (range: 85 degrees to 130 degrees) at the final follow-up (p<0.05). Preoperative and postoperative mean alignments were 9.2 degrees varus and 5.4 degrees valgus, respectively. Revisions were performed due to aseptic loosening of the tibial component in one patient, periprosthetic fracture in one and dislocation of the patella in one. Two superficial infections (3%) were observed. There was no osteolysis around the screws during the follow-up period. The overall rate of implant survival was 95.6% (range: 91.56% to 99.60%; 95% CI) at 12 years. Conclusion: Long-term outcomes of porous-coated, cementless total knee arthroplasty with screw fixation were successful in terms of clinical and radiological evaluation and yielded a high survival rate.Öğe A Newly Designed Intramedullary Nail for the Treatment of Diaphyseal Forearm Fractures in Adults(Medknow Publications & Media Pvt Ltd, 2017) Azboy, Ibrahim; Demirtas, Abdullah; Alemdar, Celil; Gem, Mehmet; Uzel, Kadir; Arslan, HuseyinBackground: The treatment of diaphyseal forearm fractures using open reduction and plate fixation is generally accepted as the best choice in many studies. However, periosteal stripping, haematoma evacuation may result in delayed union, nonunion and infection. Refracture after plate removal is another concern. To overcome these problems intramedullary nails (IM) with different designs have been used with various outcomes. However previous IM nails have some shortcomings such is rotational instability and interlocking difficulties. We evaluated the results of newly designed IM nail in the treatment of diaphyseal forearm fractures in adults. Materials and Methods: 32 patients who had been treated with the interlocking IM nail for forearm fractures between 2011 and 2014 were included in this study. There were 23 males and 9 females with mean age of 36 years (range 18-68 years). 22 patients (68.8%) had both bone fractures. Nine patients (28.1%) had open fractures. The remaining ten patients (31.2%) had radius or ulna fractures. Grace and Eversmann rating system was used to assess functional evaluation. Patient reported outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. Results: Union was achieved in all patients. The mean followup was 17 months (range 13 - 28 months). According to the Grace-Eversmann criteria, 27 patients (87.5%) had excellent or good results. The mean DASH score was 14 (range 5-36). Overall complication rate was 12.5%. Superficial infection was encountered in two patients. One patient had delayed union, however fracture healed without any additional surgical procedure. One patient who had open grade 3A, comminuted proximal third radius fracture developed radioulnar synostosis. Conclusions: The new design IM interlocking forearm nail provides satisfactory functional and radiological outcomes in the treatment of adult diaphyseal forearm fractures.Öğe Open Ankle Dislocations Without Associated Fracture(Sage Publications Inc, 2012) Ucar, Bekir Yavuz; Necmioglu, Serdar; Bulut, Mehmet; Azboy, Ibrahim; Demirtas, AbdullahBackground: This study aimed to clarify the intermediate followup results of reduction without soft tissue repair in open ankle dislocations without fracture. Methods: We retrospectively reviewed cases of open isolated ankle dislocations without associated fracture. Five male patients treated between January 2005 and July 2009 were enrolled in this study. Debridement and reduction with primary wound closure of the skin were performed without suture of the capsule or repair of the ligaments. The outcome was evaluated by the American Orthopaedic Foot & Ankle Society score (AOFAS). The time period for returning to previous level of activity was also recorded. Results: The average age of the patients was 34 (range, 27 to 44) years, and the average followup was 4 (range, 2 to 6) years. The average of the last control AOFAS score was 90 (range, 84 to 98) points. Two ankles were rated as excellent, and the other three were rated as good. Patients returned to their previous levels of physical activity at an average of 9 weeks. Conclusion: Favorable long-term results were obtained for reduction without ligament repair in pure ankle dislocations.Öğe The relationship between the quadriceps muscle strength and the anterior knee pain occurring after locked intramedullary nailing for tibial diaphysis fractures(Turkish Joint Diseases Foundation, 2011) Demirtas, Abdullah; Azboy, Ibrahim; Durakbasa, Mehmet Oguz; Ucar, Bekir Yavuz; Mercan, Ahmet Sukru; Cakir, Idris AhmetObjectives: The relationship between the quadriceps muscle strength and anterior knee pain occuring after locked tibial intramedullary nailing for tibial shaft (diaphysis) fracture was investigated. Patients and methods: Thirty-eight patients who were treated with locked intramedullary nailing for tibial shaft fractures were included in this study. The patients who had anterior knee pain before the surgery were excluded. All patients were operated on by splitting the patellar tendon in the middle and using superior approach. The fractures were all statically locked. Isometric quadriceps strengthening exercises were begun immediately in the postoperative period. The patients were divided into two groups whether they had anterior knee pain (group I; 01) or not (group 2; G2). There were 18 patients in G1 (12 males, 6 females; mean age 36.9 years) and 20 patients (14 males, 6 females; mean age 35.4 years) in G2. Quadriceps muscle strength was evaluated with using the Daniel ve Worthingham's manual grading criteria (0-5). The mean follow-up time was 27.4 months (range 11-51 months) in G1 and 30.5 months (range 12-59 months) in G2. Results: Decrease in quadriceps muscle strength was observed in eight patients in G1 and two patients in G2. The relation between anterior knee pain and decrease in quadriceps muscle strength was significant (p=0.02). Conclusion: Anterior knee pain after intramedullary nailing of tibial shaft fractures is related to quadriceps muscle weakness. However quadriceps muscle weakness is not the only effective factor that leads to anterior knee pain. Anterior knee pain can be reduced mostly with appropriate rehabilitation programme.Öğe Surgical treatment outcome for open supracondylar humerus fractures in children(Acta Medica Belgica, 2013) Ozkul, Emin; Gem, Mehmet; Arslan, Huseyin; Alemdar, Celil; Demirtas, Abdullah; Kisin, BulentAlthough numerous studies have been conducted on supracondylar humerus fractures in children, there is only a limited number of studies regarding the outcome of open fractures. In this study, the early and late outcome of open supracondylar humerus fractures in children were evaluated. The outcome in 26 children (19 males, 7 females) treated for open supracondylar humerus fractures was evaluated retrospectively. The mean age was 7.3 years (range : 4 to 14) and the mean follow-up period was 43 years (range : 2-8). According to the Gustilo-Anderson classification, 18 patients (69%) had type 1 and 8 patients (31%) type 2 open fractures. Nine patients (34%) presented with a nerve injury. Distal pulses could not be detected in four patients (15%). Functional outcomes were evaluated according to the scoring criteria by Flynn et al. Pin tract infection developed in one patient (3%). Artery repair via an anterior approach was performed in one patient. In nine patients with neurological symptoms, nerve functions were restored within three to six months. The mean union time was six weeks (5-8 weeks). According to the scoring criteria by Flynn et al, an excellent outcome was achieved in 23 patients, and a successful outcome in 3 patients. According to these findings, although vascular and nerve injuries frequently accompany open supracondylar humerus fractures in children, the late radiological and functional outcome was as good as in closed fractures.Öğe Titanium elastic intramedullary nailing: closed or mini-open reduction ?(Acta Medica Belgica, 2013) Ucar, Bekir Yavuz; Gem, Mehmet; Bulut, Mehmet; Azboy, Ibrahim; Demirtas, Abdullah; Alemdar, CelilThe authors retrospectively studied 43 children with femoral fractures, treated with titanium elastic nailing (TEN). Twenty-two underwent closed fluoroscopic reduction (Group I), whereas the other 21 underwent mini-open reduction (Group II). The operation time averaged 71 minutes in group I, and 48 minutes in group II (p < 0.001). The mean fluoroscopy time was 79.3 seconds in group I, and 35.5 seconds in group II (p < 0.001). However, blood loss and hospital stay were significantly higher in group II (p < 0.001 and p = 0.001 respectively). Time to full weight bearing, time to radiographic union and TEN outcome score did not differ significantly. Overall, no one technique was really superior. From a practical viewpoint, a mini-open reduction may be decided intra-operatively if closed reduction proves to be problematic. This decreases intra-operative radiation and length of the surgical procedure.
