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Öğe Anthropometric study of patients treated for clubfoot(Lippincott Williams & Wilkins, 2003) Kesemenli, CC; Kapukaya, A; Subasi, M; Necmioglu, S; Arslan, H; Ozbag, D; Çelik, YThe anthropometric characteristics of patients treated for clubfoot were used to investigate whether the dimensions of the foot were affected by the method of treatment. A total of 68 patients followed up for an average of 9 years were divided into three groups: group 1, conservatively treated; group 2, surgically treated; group 3, conservatively treated on one side and surgically treated on the other. The following average discrepancies in foot length were obtained: group 1, 0.91 cm; group 2, 1.5 cm; group 3, 1.09 cm. Toe lengths were shorter to the same extent as the other dimensions of the foot. These discrepancies were statistically significant. The following average discrepancies in foot width were obtained: group 1, 0.05 cm; group 2, 0.37 cm; group 3, 0.054 cm; these were insignificant. The authors believe that the degree of discrepancy may depend not solely on the method, but on the severity of the deformity as well.Öğe A case of multiple chondrosarcomas secondary to severe multiple symmetrical enchondromatosis (Ollier's disease) at an early age(W B Saunders Co Ltd, 2005) Bütke, Y; Necmioglu, S; Nazaroglu, H; Kilinc, N; Yilmaz, F[Abstract Not Available]Öğe The effects of electromagnetic field on distraction osteogenesis(Yonsei Univ Coll Medicine, 2003) Kesemenli, CC; Subasi, M; Kaya, H; Sert, C; Büyükbayram, H; Arslan, H; Necmioglu, SThe effects of electromagnetic field on distraction osteogenesis and new bony tissue were investigated. Twenty-five New Zealand rabbits were divided into an experimental (12 rabbits) and a control (13 rabbits) group. An osteotomy was performed on the right tibia in the diaphyseal region in both groups. The experimental group was exposed to a magnetic field of 50 Hz 1.0 mT for 3 hours a day for 13 weeks. The control group was kept in a similar environment but with no electromagnetic field. The distraction was continued until an increase of 10 mm was achieved. At weeks 4, 8, and 13, radiography, scintigraphy, and a biopsy were performed in both groups, and the results were statistically analyzed. The X-ray results were similar in both groups at all times. On the other hand while the scintigraphic and histopathological results were similar at weeks 4 and 13 in both groups, the osteoblastic activity was significantly greater in the experimental group at week 8 (p<0.01). In conclusion an electromagnetic field increases the osteoblastic activity and osteogenesis, but has little effect during the remodeling phase.Öğe Frontal cephalometric analysis in the evaluation of facial asymmetry in torticollis, and outcomes of bipolar release in patients over 6 years of age(Springer, 2002) Arslan, H; Gündüz, S; Subasy, M; Kesemenli, C; Necmioglu, SBackground: The aim of this study was to investigate the mid-term results of bipolar release in congenital muscular torticollis patients over 6 years of age, and the efficacy of frontal cephalometric analysis in the determination and follow-up of facial asymmetry. Methods: Twelve patients (9 boys, 3 girls) from 7 to 12 years of age were included in the study. Bipolar release was performed, followed by 5-7 days of traction and 3 months of physiotherapy. Posteroanterior cephalometric radiography was performed at the beginning of and after therapy. The postural symmetry angle (PSA) was used to determine the presence and severity of facial asymmetry. A modified version of Lee et al.'s system was used in evaluating the results. Results: The average follow-up period was 3 years and 5 months. According to the congenital muscular torticollis evaluation system, the outcome was excellent in 2 of the patients, good in 6, fair in 2 and poor in 2. Asymmetry was not severe in all patients at the beginning of therapy according to PSA values, being insignificant in 2, mild in 6, and severe in 4. The PSA results of the last examination indicated that severe facial asymmetry persisted in 3 patients. In 2 of them, PSA values remained within the limits of severe asymmetry despite a slight angular correction. Discussion: Congenital muscular torticollis patients can benefit from surgical treatment over the age of 6 years. Bipolar release is an adequate and complication-free method. Moreover, PSA may be used as an objective method in the determination and follow-up of facial asymmetry in torticollis patients.Öğe Frontal cephalometric analysis in the evaluation of facial asymmetry in torticollis, and outcomes of bipolar release in patients over 6 years of age (vol 122, pg 489, 2003)(Springer-Verlag, 2003) Arslan, H; Gündüz, S; Subasi, M; Kesemenli, C; Necmioglu, S[Abstract Not Available]Öğe Is external fixation in pediatric femoral fractures a risk factor for refracture?(Lippincott Williams & Wilkins, 2004) Kesemenli, CC; Subasi, M; Arslan, H; Tüzüner, T; Necmioglu, S; Kapukaya, AThe aim of this study was to investigate whether external fixation is a risk factor for refracture by comparing the outcomes of children who received three different forms of treatment of femoral fractures. One hundred ninety-two patients treated for femoral fracture between 1990 and 1999 who underwent final examination were assessed. One hundred were treated with hip spica casting after traction, 57 with closed reduction and external fixation, and 35 with open reduction and external fixation. Morbidity results such as time to union, length of hospital stay, refracture, and wire site infection were statistically evaluated. Patients undergoing open reduction had a greater time to union and length of hospital stay and a higher refracture rate. The difference was statistically significant. Wire site infection occurred in all three groups; there was no statistically significant difference between groups. The authors concluded that external fixation is not a risk factor for refracture in the treatment of pediatric closed femoral diaphyseal fractures, and that it may be used with case in clinics with shortages of personnel and space.Öğe Long-term outcomes of conservatively treated paediatric pelvic fractures(Elsevier Sci Ltd, 2004) Subasi, M; Arslan, H; Necmioglu, S; Onen, A; Özen, S; Kaya, MThe long-term orthopaedic, urologic, and psychiatric outcomes of patients treated non-operativety for unstable pelvic fractures were assessed. There were 55 mates and 3 females with an average age of 7 (3-13). Eighty-one percent of the fractures were caused by motor vehicle accidents, and 68% by auto-pedestrian accidents. Thirty-four of the 58 fractures were type Tile type B and 24 were type C. Posterior urethral injury was determined in 41 patients, and head injury in 21. Three patients with type C injury died within the first 3 days. After an average follow-up period of 7.4 years of the patients with type B injuries, leg length discrepancy of 1 cm was determined in two, and limited motion associated with open-knee wound in one, and tow back pain in two. Of the patients with type C injuries, low back pain was found in four, gait abnormality in three, sacroiliac ankylosis in one, and symphyseal ossification in two. Urethral. stricture was determined in 11 patients, urinary incontinence in 6 and erectile dysfunction in 6. A total of 31 patients were diagnosed with 41 psychiatric illnesses, including dysthymic disorder, social phobia, post-traumatic stress disorder, and major depression. No difference was found in the treatment outcomes of the two groups. From a holistic standpoint, Long hospital stays and urologic complications are associated with serious psychological problems, and thus should be considered during selection of treatment modality. (C) 2004 Elsevier Ltd. All rights reserved.Öğe Lower limb landmine injuries(Sage Publications Ltd, 2004) Necmioglu, S; Subasi, M; Kayikci, C; Young, DBThe medical records of 186 patients seeking treatment for landmine injuries in the authors' re-ion between 1993 and 2001 were evaluated. Of these patients 13 died of accompanying complications. Ten (10) patients with general body trauma and upper limb trauma were excluded from the study. Of 163 patients with lower-limb injuries included in the study, 21, with traumatic amputation underwent surgical amputation at different levels. Patients without traumatic amputation were divided into 2 groups. There were 41 patients (29%) in Group I who were treated by limb salvage procedures. Treatments used in Group I including wound debridement, tendon repair, skin approximation, minimal osteosynthesis, external fixation of long bones and secondary, wound coverage. In Group 11, there were 101 patients (71%) with primary amputation. Trans-tibial amputation was performed in 52 cases (51.4%), ankle disarticulation in 24 (23.7%), trans-femoral amputation in 9 (8.9%), partial foot amputation in 8 (7.9%), knee disarticulation in 7 (6.9%) and hip disarticulation in I case. In Group 1, there was infection in 21 patients (51.2%), revision in 27 (65.8%), and amputation in 15 (36.5%). In Group 11, there was infection in 28 patients (27.7%), revision in 17 (16.8%), and amputation at a higher level in 8 (7%). In crush injuries such as those resulting from landmines, soft tissue, vascular, and neurological assessment must be performed with utmost care. Even so, the desired success in interventions intended to save a limb is complicated by a high infection rate, soft tissue complications, and high revision amputation rates. Therefore, a decision to amputate in the early term based on an accurate preoperative assessment is crucial.Öğe Problem fractures associated with gunshot wounds in children(Elsevier Sci Ltd, 2002) Arslan, H; Subasi, M; Kesemenli, C; Kapukaya, A; Necmioglu, S; Kayikçi, CTwenty-seven fractures in 22 children (14 female, 8 male; average age: 10.5) who suffered gunshot wounds were retrospectively evaluated. Fourteen of the fractures were caused by high-velocity weapons, four by low-velocity weapons, and nine by shotguns. One of the fractures was undisplaced, two were displaced, 10 were comminuted, seven were comminuted and displaced, and seven had bony defects. Accompanying pathologies included four physeal, three articular, four visceral, four arterial, six peripheral nerve, and one spinal cord injury. Initial treatment involved external fixation in 15 patients and internal fixation in one patient for bone stabilization, while the remaining patients were treated conservatively. Late-stage surgery was necessary to achieve soft-tissue coverage in three patients and to achieve union in six patients. Major complications included amputation in one patient, non-union in two, delayed union in one, osteomyelitis in one, paraplegia in one, and loss of peripheral nerve functions in three. The treatment of fractures associated with firearm injuries in children is never simple. Fracture defects, accompanying peripheral nerve damage and involvement of the joint negatively is affect the outcome, increasing the chance that late-stage surgery will be necessary. Internal bone transport appears to be an efficacious technique in the treatment of bone and soft-tissue defects associated with firearm injuries in children. (C) 2002 Elsevier Science Ltd. All rights reserved.Öğe The results of rehabilitation on motor and functional improvement of the spinal tuberculosis(Editions Scientifiques Medicales Elsevier, 2004) Nas, K; Kemaloglu, MS; Çevik, R; Ceviz, A; Necmioglu, S; Bükte, Y; Cosut, AObjectives. - To evaluate the result of rehabilitation on motor and functional improvement in spinal tuberculosis. Method. - Prospective case study. Data were collected from 47 patients with spinal tuberculosis medically and/or surgically treated, and rehabilitated over 6 months of period, after spinal decompression and fusion. The main outcome measures were motor development of the patients who were evaluated at the beginning, in the 1st week, in the 3rd month, and in the 6th month. Functional development of the patients was evaluated at the beginning and in the 6th month. Functional assessment was made according to Modified Barthel Index (MBI), and motor examination was made according to American Spinal Injury Association (ASIA). Results. - The study population consisted of 47 patients (22 males and 25 females) mean aged 37.9 +/- 18.3 years (range 5-76 years). The most common site of spinal tuberculosis was the thoracic region. Localized back pain, paraparesis, sensory dysfunction and fever were typical clinical manifestations. Surgical management was performed as anterior or posterior drainage of abscess and/or stabilization of the spine. The rehabilitation program was performed in all patients during the preoperative, early postoperative and late postoperative 6 month periods. Muscle-strengthening exercises on necessary localization such as pectoral, abdominal, lower extremities; truncal and sacrospinal extensors were started for the rehabilitation. The motor score for the lower limbs and the MBI scores for activities of daily living (ADL) and mobility improved significantly (P < 0.001). The self-care and mobility categories of the MBI on admission; were 14.8% severely dependent and 10.6% independent. However, at the end of the rehabilitation program, 4.2% were severely dependent and 70.2% independent. In conclusion. - Early diagnosis and appropriate medical and/or surgical treatment together with a rehabilitation program will improve the life quality of patients with spinal tuberculosis. (C) 2003 Elsevier SAS. All rights reserved.Öğe Treatment of closed femoral diaphyseal fractures with external fixators in children(Springer Verlag, 1998) Kapukaya, A; Subasi, M; Necmioglu, S; Arslan, H; Kesemenli, C; Yildirim, KFrom August 1992 to July 1996, 57 patients with closed femoral fractures were treated by external fixator in the Orthopaedic and Traumatology Clinics, School of Medicine, Dicle University. The technique was applied to children with closed femoral fractures. Their mean age was 6 (range 4-12) years old. The mean hospitalisation period was 8 (range 5-15) days. Fixators were removed on an average of 55 (range 38-79) days. The mean follow-up period was 18 (range 9-36) months. Pintract infection was observed in 3 and refracture in 1 patient. Infection was controlled with oral antibiotics and local dressing;. An external fixator was applied to a patient in whom refracture developed. No patient had malunion, nonunion, or leg length discrepancy. We propose that external fixation in closed femoral shaft fractures of children could be a rational alternative mode of therapy, since it has some advantages and can be easily removed without undergoing a second round of anaesthesia.Öğe Treatment of multifragmentary fractures of the femur by indirect reduction (biological) and plate fixation(Elsevier Sci Ltd, 2002) Kesemenli, C; Subasi, M; Necmioglu, S; Kapukaya, AWe present a retrospective review of the results of 43 multifragmentary femur fractures treated under the principle of indirect reduction (biological) and plate fixation. Fractures were caused by high-energy trauma in all patients. Sixteen were subtrochanteric, 14 diaphyseal and 13 supracondylar. There were 13 open fractures. In six of the patients with diaphyseal fractures, a plate wits inserted through isolated proximal and distal incisions only, deep to the vastus lateralis. None of the fractures was treated with bone graft. The mean follow-up time was 28.3 months. Union was achieved in 41 patients within a mean period of 4.25 months. There was delayed union in one patient (subtrochanteric), non-union ill two, infection in three, malunion in three, leg shortening in six and mild knee stiffness in seven. In eight patients with diaphyseal fractures in whom a single incision was performed, the average time for fracture healing was 4.14 months ill seven and non-union developed in one. In six patients with diaphyseal fractures, in whom proximal and distal incisions were performed, the average time for fracture healing was 4 months. There was no difference (P > 0.05) between single and double incision with reference to infection and time to union, but the indirect reduction methods must be meticulously implemented. The implants we used are cheaper and more easily Supplied than many others. The Success rate is high when the technique is correctly implemented. We believe that this is a treatment of choice ill Countries with low socioeconomic status, no efficient health insurance system and no intraoperative image intensification. (C) 2002 Elsevier Science Ltd. All rights reserved.Öğe Use of the vastus lateralis muscle flap with a grooving procedure in the surgical treatment of chronic osteomyelitis of the femur(Lippincott Williams & Wilkins, 2004) Necmioglu, S; Askar, I; Lök, V; Subasi, MSevere femoral fractures may be associated with devascularization of cortical bone, soft-tissue loss, and significant morbidity. After surgical treatment of these femoral fractures, chronic infection may ensue and requires additional reconstructive procedures. Local muscle flap coverage is used to treat chronic osteomyelitis. A new procedure-the vastus lateralis muscle flap with grooving of the femoral shaft-was used for the treatment of chronic osteomyelitis of the femoral shaft. The authors present 6 patients with chronic osteomyelitis of the femur who were treated with a vastus lateralis muscle flap. Five of the patients were male and the other was female. The average age of the patients was 33.8 years (range, 17-54 years). All patients experienced infection during the early postoperative period. Drainage of abscess, debridement, sequestrectomy repair of fistula, and mini fenestration were performed at least 3 times, and antibiotics were administered several times. During the operations, tissue samples were evaluated for bacterial cultivation. Staphylococcus aureus was seen in 4 patients, S. epidermidis in 1 patient, and Pseudomonas aeruginosa in the remaining patient. A vastus lateralis muscle flap with grooving of the infected femoral shaft is presented. The authors have not encountered a recurrence of infection during a minimum 3.9 years of follow-up. They think this technique is an alternative to the current techniques for the surgical treatment of chronic osteomyelitis of the femur.
