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Öğe Distraction osteotomy for malunion of the distal end of the radius with radial shortening(2003) Arslan H.; Subasi M.; Kesemenli C.; Kapukaya A.; Necmioglu S.The treatment and outcomes of distraction osteotomy in 9 patients with malunion of the distal radius with radial shortening are presented. The patients had an average age of 32 years (range: 14 to 36 years) and comprised 7 males and 2 females. Ulnar inclination was below normal in all patients, volar inclination was below normal in 8 patients, and the average radial length discrepancy was 7.6 mm (range: 4 to 16 mm). Angulations in the distal radius were corrected by manipulation after osteotomy, and shortening by callus distraction. In order to achieve normal radial length, distraction was performed for an average of 10.2 days (range: 7 to 19 days), and union occurred in an average of 10.7 weeks (range: 9 to 13 weeks). During the waiting period between distraction and consolidation, impairment of ulnar and volar inclination recurred in 3 patients, and translation of the distal fragment necessitating correction occurred in 3 patients. No cases of nonunion or malunion were observed. In all patients, there was a decrease in cosmetic and pain-related complaints, and improvement in wrist movements. Distraction osteotomy is a simple and effective treatment for malunion of the distal radius with concurrent radial shortening. However, the position of the distal fragment should be followed up until consolidation.Öğe The effects of osteoporosis on distraction osteogenesis: An experimental study in an ovariectomised rabbit model(2003) Arslan H.; Ketani A.; Gezici A.; Kapukaya A.; Necmioğlu S.; Kesemenli C.; Subasi M.The effects of oestrogen deficiency-associated osteoporosis on callus distraction were investigated in rabbits. Twenty-four female New Zealand rabbits 5 to 6 months old were used. Ovariectomy was performed on 12 rabbits, which composed the osteoporotic model group. Six weeks later, osteotomy was carried out and Ilizarov external fixators were applied to the right proximal tibial metaphyses in both the osteoporotic model group and the control group. Beginning one week postosteotomy, the metaphyses were distracted 0.35 mm twice daily for 3 weeks, and the average length increase obtained for both groups was 17.2 mm (minimum: 16.8, maximum: 19 mm). Following a postdistraction waiting period of 6 weeks for newbone formation, the subjects were sacrified and specimens were examined histopathologically. Radiography was carried out at one-week intervals during the distraction period and at 2-week intervals during the waiting period, and scintigraphy was performed at the end of each period. On histopathologic examination, a significant difference in callus remodeling was observed between the control and osteoporotic model groups. On radiologic evaluation it was observed that, while both groups had inadequate callus tissue at the end of the waiting period, callus formation and remodeling occurred later in the model group than in the control group, and the new bone was more osteoporotic. Osteoporosis associated with estrogen deficiency adversely affects the outcome of callus distraction. Nonetheless, radiographic findings in rabbits indicate that the effects may not be so great as to preclude clinical procedures. It was concluded that these results should be supported with clinical studies.Öğe Popliteal artery injuries associated with fractures and dislocations about the knee(2001) Subasi M.; Cakir O.; Kesemenli C.; Arslan H.; Necmioglu S.; Eren N.The authors present the results of a retrospective review of popliteal artery injuries associated with fractures and dislocations about the knee. They treated 41 patients with popliteal artery injuries associated with either fractures about the knee or knee dislocations. Thirty-five of the patients were males, 6 females; the mean age was 23 years. The delay before accessing the hospital was 17 hours (range: 3 hours to 10 days). Thirty-two fractures were open. Together with the vascular injury, 12 femoral fractures, 20 tibial and fibular fractures, 5 knee dislocations, 4 femoral + tibial fractures were identified. Twenty-three patients underwent external fixation, 8 internal fixation, 6 plaster cast immobilization, 4 minimal osteosynthesis and plaster cast immobilization. The arterial injury was treated by end-to-end anastomosis in 5 cases, saphenous vein anastomosis in 29 cases and thrombectomy in 7 cases. Nine patients were amputed. Delay in surgery, blunt trauma, extensive soft tissue defect and bone fracture or dislocation, are associated with high amputation rate following popliteal artery injury. The influence of each of these factors alone on the amputation rate could not be evaluated in this study, as no statistically significant correlation could be demonstrated.Öğe Rarely seen fractures(2001) Subaşi M.; Kapukaya A.; Kesemenli C.; Coban V.Rarely seen fractures are presented in this study. One case was a calcaneal spur, 2 cases osteochondroma pedicule fractures and talus posteromedial tubercle fracture due to direct trauma. Calcaneal spur and osteochondromas were removed surgically and posteromedial tubercle was treated by short-leg cast immobilization. In conclusion, we think that fractures of osteochondroma and calcaneal spur may be treated by surgical removal which do not cause any functional disorders after this operation, but fractures like the talus posteromedial tubercle should be treated conservatively by short-leg immobilization in the early period.Öğe Supracondylar process of the humerus(2002) Subasi M.; Kesemenli C.; Necmioglu S.; Kapukaya A.; Demirtas M.Four cases of supracondylar process of the humerus in three patients are presented. The main features of a supracondylar process as compared with an osteochondroma are reviewed. The three patients had pain and one had signs indicating median nerve compression. One had a supracondylar process together with an osteochondroma in the contralateral supracondylar region. One patient with a bilateral supracondylar process refused an operation. The other two patients underwent surgical treatment. The symptoms disappeared in the two patients who were operated.Öğe Treatment of intertrochanteric fractures by external fixation(2001) Subasi M.; Kesemenli C.; Kapukaya A.; Necmioglu S.In this study, we aimed to evaluate the results of treatment of intertrochanteric fractures of the femur by external fixation in 33 patients with an average age of 65.9 years. Patients in the study had Evans stable type 1 intertrochanteric fractures and unstable type 1 fractures that could be reduced to anatomical or nearly anatomical position by closed manipulation under fluoroscopy. The average follow-up period was 24 months (range, 12 to 40 months). There was no mortality in the early postoperative period, but the mortality within six month following surgery was 39%. Complete fracture healing was achieved in all patients. The fixator was removed after an average of 94 days (75 to 130 days) at the outpatient clinic. Varus malalignment of more than 20° and limb shortening greater than 2 cm were noted in 3 patients. Pin-tract infection was seen around 10 pins (7%). Osteomyelitis was not noted in any patients. Treatment of intertrochanteric fractures by external fixation is simple and can be done under local anesthesia together with narcotic analgesic support. It allows early mobilization, and implant removal is easy. Therefore we think that external fixation is a valuable alternative in high-risk geriatric patients.Öğe Treatment of intertrochanteric fractures in elderly patients with Leinbach type endoprostheses(2001) Kesemenli C.; Subaşi M.; Arslan H.; Kirkgöz T.; Necmioglu S.Intertrochanteric fractures are seen in elderly ages and occur mostly by minor trauma. Mortality and morbidity rates are high and internal fixation and external methods are used for the treatment. Twenty-seven patients with intertrochanteric fractures who were at the mean age of 78 ranging between 71-95 and were treated by Leinbach type endoprosthesis during 1995-1999 were evaluated. Fourteen (%51) patients were female and 13 (%49) were male. The patients underwent operation as early as they were convenient. If they could, they were advised to walk at the second or third day of the operation. Two (%7) patients died at the end of the operation and 1 (%3.7) patient died during the first week after the operation. The patients were followed up mean 14(5-21) months and evaluated according to the criteria of American Academy of Orthopedic Surgeons which displayed good results in %80 of patients. In elderly patients with intertrochanteric fractures due to pathologies and related complications and also complications due to immobilization are seen frequently. Treatment with endoprosthesis is thought to be helpful in decreasing these complications and early mobilization of the patients.Öğe Treatment of traumatic bone defects by bone transport(2001) Kesemenli C.; Subasi M.; Kirkgoz T.; Kapukaya A.; Arslan H.This study retrospectively evaluates the results of the management using the callus distraction method, of 19 patients who had developed bone defects following acute trauma. Sixteen patients were males, with a mean age of 19.4 years (6-41 years). Thirteen patients developed bone defects as a result of high-velocity gunshot injuries, and six had defects caused by traffic accidents. The location of 12 fractures was the tibia, and seven were in the femur. The mean follow-up period was 23.6 (12-40) months. The mean length of the bone defect was 6.8 cm (4-16 cm), the distraction index was 13.3 days/cm (7.5-18 days/cm) and the external fixation index was 36.6 days/cm (32.5-46 days/cm). Fifteen (9%) pintract infections were observed among those who underwent circular external fixation and four (10%) in cases who underwent unilateral external fixation. There were no deep infections. Refracture was noted in one patient (5%), and two (11%) had delayed union at the target site. One patient developed nonunion at the target site. For the treatment of large bone defects, the callus distraction method may be an alternative option to conventional treatment methods.Öğe The treatment outcomes of children with Gustilo-Anderson grade II and grade III open fractures of the long bone(2002) Arslan H.; Necmioglu S.; Kesemenli C.; Subaşi M.; Ersuz H.BACKGROUND: We evaluated the treatment results in thirty-two children who had grade 2 and 3 open fractures according to classification of Gustilo-Anderson. METHODS: There were 21 (%65) male and 11 female (%35) patient and the mean age was 9 years (range, 4-14 years). There were 18 (%56) grade-2, 7 (%22) grade-3A, 5 (%15) grade-3B, and 2 (%6) grade-3C open fracture. All fractures were irrigated and debrided, and then fixed with external fixators. The average duration of follow-up was 11 months (range, 6-28 month). RESULTS: All fractures healed. Inadequate recovering was detected in four patients who had nerve injury, in addition the joint limiting contracture occurred on six patients. CONCLUSION: Fracture union without segmental bone loss is not a significant problem in open fractures in children, and that joint contractures, compartment syndrome and nerve injuries negatively affect the late outcomes.
