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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 Effect of neoadjuvant chemotherapy on distraction osteogenesis in the goat model [5] (multiple letters)(Lippincott Williams and Wilkins, 2004) Subasi M.; Kapukaya A.; Gravel C.[No abstract available]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 Giant-cell reparative granuloma of the tibia(2003) Subasi M.; Kapukaya A.; Buyukbayram H.; Bukte Y.Giant-cell reparative granuloma (GCRG) occurs in the jaw, temporal bone, and short tubular bones of the hands and feet. Although GCRG can affect long bones, only small numbers of such cases have been sporadically reported. This report describes a giant-cell reparative granuloma in the proximal tibia in a 60-year-old woman, describes features of GCRG in long bones and reviews the literature. A 60-year-old female patient was referred to us with complaints of moderately tender swelling of the right leg. Whole-body scintigraphic scanning was performed, which incidentally also disclosed a distal femoral lesion. The patient was admitted for surgery and incisional biopsies were performed on both lesions. Pathology analysis of the specimen from the tibia showed new bone lamellæ encircled by osteoblasts and multinucleated giant cells which were more numerous in the hæmorrhagic regions of the stroma; the latter displayed fibroblasts, histiocytes and inflammatory cells. The specimen from the femoral lesion showed typical features of a benign enchondroma. The patient was readmitted for surgery. The femoral enchondroma was curetted and the cavity was packed with bone graft. The tibial GCRG was treated with marginal resection, autogenous and allogenous bone grafting and intramedullary nailing. Follow-up examination after two years showed no clinical or radiological evidence of a recurrence. Although GCRG is uncommon, it should be considered whenever a lucent, expansile, and possibly destructive lesion of a long bone is encountered. It should be distinguished from true giant cell tumours occurring in the same locations because they have different biologic behaviours.Öğe Management of comminuted closed tibial plafond fractures using circular external fixators(2005) Kapukaya A.; Subasi M.; Arslan H.Various types of external fixators have been used to treat Ruedi and Allgöwer Type III pilon fractures, as serious complications can occur using conventional treatment principles. However, insufficient reduction and loss of reduction are two of the main disadvantages of external fixator treatments. We conducted a retrospective review of 14 patients with severe highly comminuted closed fractures of the distal tibia (Ruedi type III) treated using cross-ankle external fixators. Five patients underwent closed reduction, while the others required open reduction using minimal incision techniques. The reduction score, reduction loss, early and late complications, and ankle symptoms and functions were evaluated. The patients were followed for an average of 48 months (range: 31 to 84); superficial wound infection developed in one case and minimal angular deformity in another. In ten cases, the reduction of the articular surface was anatomical; in the other four cases, it was non-anatomical. Except for one case which developed an angular deformity, no loss of reduction was observed. On radiological control, only one case did not display osteoarthrosis; in the other 13 cases, osteoarthrosis was diagnosed at different levels. The most important disadvantage of this technique is retarded joint movement. Nevertheless, for such fractures, we consider cross-ankle circular external fixators as an alternative treatment method because it combines the advantage of a minimal risk of deep infections with better stabilisation of the limb, while providing early mobilisation. © 2005, Acta Orthopædica Belgica.Öğe Osseous lipoma: Eleven new cases and review of the literature(2006) Kapukaya A.; Subasi M.; Dabak N.; Ozkul E.This study describes the clinical features, radiological appearance, and treatment of 11 new cases of osseous lipoma and reviews 301 other cases in the literature. Osseous lipomas are classified by the site of origin: either within bone (intraosseous lipoma) or on the surface of bone (juxtacortical). Intraosseous lipomas include intramedullary and intracortical lesions. Surface lipomas include subperiosteal and parosteal lesions. The authors added their cases to those found in the literature. Intramedullary osseous lipoma (n = 262): the most common presenting symptoms were pain and swelling (69%). The most frequent localisations were the calcaneus (24%) and the femur (22%). On plain radiographs, these lesions consisted of a well-circumscribed radiolucent area with central calcification and a sclerotic rim, occasionally with cortical expansion. Computed tomography (CT) and magnetic resonance imaging (MRI) showed that the lesions had attenuation values and a signal intensity identical to that of adipose tissue. In symptomatic lesions and in cases with impending fracture, operative treatment was indicated. Parosteal lipoma (n = 47): the most common presenting symptoms were local swelling and pain (58%). This lesion was most frequent in the radius (31%) and in the femur (23%). The classic radiographic appearance of parosteal lipoma was that of an exostosis-like bony prominence capped with a radiolucent layer of fat. CT-scan and MRI showed similar features. Intracortical (n = 2) and subperiosteal lipomas (n = 1): only a few cases were found in the literature. Their localisation differs from that of the other osseous lipomas. The differential diagnosis of osseous lipoma in general is extensive and should include benign and malignant tumours. Combination of radiological and histological data is essential to determine whether an osseous lipoma is actually present. © 2006, Acta Orthopædica Belgica.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 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 humeral diaphyseal nonunions by interlocked nailing and autologous bone grafting(2002) Kesemenli C.C.; Subasi M.; Arslan H.; Necmioğlu S.; Kapukaya A.Twenty seven patients with humeral diaphyseal nonunion treated with interlocked nailing and autogenous bone grafting were retrospectively assessed. The mean age was 37 years (28 to 59 years). There were 16 women and 11 men. An average of 11 months (8 to 36 months) had elapsed between the initial trauma or treatment and presentation in our clinic. The nonunion site was in the distal third of the humerus in 18 patients (66%) and in the middle third in 9 (34%). Seventeen (73%) had hypertrophic and 10 (37%) atrophic nonunion. Patients were treated with locked intramedullary nailing and autogenous cancellous bone grafting. The mean follow-up was 42 months (28 to 62 months), and the mean time to union was 4.8 months (2.5 to 11 months). Three patients developed superficial infection. Union was achieved in all cases but one, in which there was multiple nerve injury. According to Steward and Hundley's scoring, results were good in 24 patients, fair in 2, and poor in one. Interlocked nailing and autologous bone grafting has a good rate of union provided nails of appropriate diameter are used and distal and proximal locking is performed correctly. We think that its low rate of infection, low risk of injury to the radial nerve, and low requirement for soft tissue dissection make it a suitable choice in the treatment of nonunions of the humeral diaphysis.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 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.
