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    Effect of graft application and nebivolol treatment on tibial bone defect in rats
    (Sci Printers & Publ INC, 2021) Gem, Mehmet; Şahin, İlhami; Uzel, Kadir; Ermiş, Işılay Sezen; Deveci, Engin
    OBJECTIVE: To evaluate the results of the effect of nebivolol on tibial bone defect and graft application in new bone development in the rat. STUDY DESIGN: Thirty Wistar albino rats were divided into 3 groups. In the Control group, tibia bone defect was created without any treatment. In the Defect+ Graft group, allograft treatment was performed by forming a 6 mm tibial bone defect. In the Defect+ Graft+ Nebivolol group, alloplastic bone graft was placed in the calvarial bone defect and then nebivolol (0.34 mg/mL solution/day) treatment was intraperitoneally applied for 28 days. RESULTS: Histopathological examination revealed inflammation in the defect area, congestion in the vessels, degeneration in collagen fibers, and an increase in osteoclast cells. There was an increase in inflammation and blood vessel structure in graft application, and osteoblastic activity matrix formation after reorganization nebivolol application in collagen fibers. Osteonectin expression was positive in the collagen fiber and matrix, starting in the Graft group, in osteoblasts, whereas in the Nebivolol group, osteoblasts increased in osteocytes and new bone formation. CONCLUSION: Nebivolol is thought to have a positive effect on osteoinductive bone growth factors and contribute to the cell-matrix interaction, in addition to the supporting effect of the graft with its antioxidative effect.
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    An evaluation of treating non-union of femoral neck fractures with valgus angulation osteotomy using sliding hip screws
    (Acta Medica Belgica, 2019) Ozkul, Emin; Necmioglu, Necdet Serdar; Ziyadanogullari, Mehmet Onur; Alemdar, Celil; Arslan, Huseyin; Uzel, Kadir
    This study presents the outcomes of patients treated with non-union of femoral neck fractures healed with valgus osteotomy, fixed with a Dynamic Hip Screw (DHS). The study retrospectively evaluated 16 patients who, between 2007 and 2014, developed pseudarthrosis following treatment for a femoral neck fracture and who were treated with DHS-osteosynthesis, after a valgus subtrochanteric osteotomy. Postoperative clinical evaluation of the patients was done? using the Harris Hip Scoring (HHS) system. Union of both the fracture and the osteotomy site was achieved in 17.2 weeks (range: 14-24 weeks) in all patients. The average Pauwels angle decreased from 72o (range 62-80) preoperatively to 26o (range 20-50) postoperatively. All fractures were Pauwels type HI preoperatively and 4 type II and 12 type I postoperatively. The average HHS increased from 26 (range 18-34) preoperatively to 85 (range 68-94) postoperatively. Of the patients who were followed up for a mean duration of 3.1 years (range: 1-5 years), four had 1-cm shortening. No patient developed postoperative AVN of the femoral head. For patients with non-union after femoral neck fracture, DHS-osteosynthesis after valgus osteotomy is a method with a shorter learning curve, which can be successfully performed.
  • Küçük Resim
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    Functional and radiologic results of posteromedial limited surgery in developmental dysplasia of the hip
    (Galen, 2023) Uzel, Kadir; Gem, Mehmet; Şahin, İlhami; Ziyadanoğulları, Mehmet Onur; Eskandari, Mehmet Manouchehr; Arslan, Hüseyin
    PURPOSE OF THE STUDY In treatment algorithm of developmental dysplasia of the hip, posteromedial limited surgery is placed between closed reduction and medial open articular reduction. The aim of the present study was to assess the functional and radiologic results of this method. MATERIAL AND METHODS This retrospective study was performed in 37 Tönnis grade II and III dysplastic hips of 30 patients. The mean age of the patients at operation was 12.4 months. The mean follow-up time was 24.5 months. Posteromedial limited surgery was applied when sufficient stable concentric reduction was not achieved by closed technique. No pre-operative traction was applied. Postoperatively, human position hip spica cast was applied for 3 months. Outcomes were evaluated regarding modified McKay functional results, acetabular index and presences of residual acetabular dysplasia or avascular necrosis. RESULTS Thirty-six hips had satisfactory and one hip had poor functional result. The mean pre-operative acetabular index was 34.5 degrees. It improved to 27.7 and 23.1 degrees at the postoperative 6th month and the last control X-Rays. The change in acetabular index was statistically significant (p<0.05). At the last control, 3 hips had findings of residual acetabular dysplasia and 2 hips had avascular necrosis. CONCLUSIONS Posteromedial limited surgery for developmental dysplasia of the hip is indicated when closed reduction remains insufficient and medial open articular reduction remains unnecessarily invasive. This study, in line with the literature, provides evidences that this method might decrease the incidences of residual acetabular dysplasia and avascular necrosis of the femoral head.
  • Küçük Resim
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    Functional outcomes and quality of life in adult ipsilateral femur and tibia fractures
    (Elsevier (Singapore) Pte Ltd, 2019) Demirtaş, Abdullah; Azboy, İbrahim; Alemdar, Celil; Gem, Mehmet; Özkul, Emin; Bulut, Mehmet; Uzel, Kadir
    Objective: The aim of our study is to evaluate the functional outcomes and quality of life in adult ipsilateral femur and tibia fractures. Methods: 26 patients (21 male, 5 female; mean age 30 years, range: 18 to 66) treated for adult ipsilateral femur and tibia fractures were evaluated retrospectively. For femur fractures, intramedullary nails were used in 15 patients (12 antegrade, 3 retrograde), plate in 11 patients (10 locked-plate, and 1 blade-plate with a 95 degree angle). For tibia fractures, locked-plate were used in 13 patients, intramedullary nails in 9 patients, external fixator in 3 patients and multiple screws in 1 patient. According to Blake and McBryde classification, 17 fractures were type I, 9 fractures were type II (7 type 2A and 2 type 2B). The functional outcomes were evaluated by Karlström and Olerud criteria, and quality of life was evaluated by Short Form-36. The mean follow-up duration was 4.4 years (range: 1.1 to 7.3 years). Results: The functional outcomes were excellent in 6 patients, good in 8 patients, acceptable in 6 patients and poor in 6 patients. The mean values of quality of life scales were; physical function: 64.8, physical role limitation: 60.5, pain: 68.2, general health: 63.3, vitality: 58.4, social function: 68.2, emotional role limitation: 62.7, and mental health: 65.8. Conclusion: Adult ipsilateral femur and tibia fractures are severe injuries and adversely affect the quality of life and functional outcomes. The quality of life scales should be used along with functional outcome scores in evaluating these injuries. The translational potential of this article: Adult ipsilateral femur and tibia fractures cause severe morbidity. Functional outcomes and quality of life scales should be used together to evaluate these fractures. Karlström and Olerud criteria for functional outcomes and Short Form-36 scales for quality of life are suitable methods to evalute these fractures.
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    Gelişimsel kalça displazisinde medial sınırlı açık redüksiyon sonuçları
    (2015) Uzel, Kadir; Arslan, Hüseyin
    Amaç: Gelişimsel kalça displazisi tedavisinde Tönnis tip II ve III kalçalarda eklem kapsülü açılmadan, ekstrakapsüler yapıları gevşeterek uygulanan sınırlı açık redüksiyon tekniği yeni bir tedavi şeklidir. Bu çalışmada Tönnis tip II ve III GKD’li hastalarda intraoperatif artrografi eşliğinde posteromedial girişimle sınırlı açık redüksiyon yapılan, konsantrik ve stabil redüksiyon elde edilen hastaların klinik ve radyolojik sonuçları incelendi. Materyal ve Metod: Gelişimsel kalça displazisi nedeniyle posteromedial girişimle eklem kapsülü açılmadan intraoperatif artrografi eşliğinde sadece addüktor longus ve iliopsoas tenotomileri yapılan, takip süresi en az 18 ay olan Tönnis tip II ve III kalça çıkıklı 27’si kız, 3’ü erkek toplam 30 hastanın 37 kalçası çalışmaya dahil edilerek retrospektif olarak incelendi. Hastaların; preoperatif, postoperatif ve son kontrol asetabuler indekslerine, McCay klinik değerlendirme kriterlerine, radyolojik değerlendirmelerine, Kalamchi-MacEwen değerlendirme sistemine göre aldıkları skorlara bakıldı ve sekonder asetabuler girişim gereksinimleri bakımından değerlendirildi. Olgularımızda sekonder asetabuler displazi kriterleri ile hastaların sekonder asetabuler girişim ihtiyacı Shenton-Menard hattının kırılmasına, redüksiyondan 2 yıl sonra asetabuler indeksin 35° ve daha yüksek olmasına ve asetabuler kaşın (sourcil) yukarıya doğru eğimli olmasına göre belirlendi. Bulgular: Hastaların en küçüğü 5 aylık, en büyüğü 23 aylık olup yaş ortalaması 12.36 ay idi. Takip süresi en az 18 ay, en fazla 43 ay olup ortalama 24.53 ay idi. Otuz yedi kalçanın preoperatif asetabuler indeks açı ortalaması 34,5135 (±4,574), postoperatif asetabuler indeks açı ortalaması 27,7297 (±4,433), son kontrol asetabuler indeks açı ortalaması 23,0541 (±5,328) olup, dönemlerdeki tekrarlanan açısal değerler istatistiksel olarak anlamlı değişim göstermiştir (F=85,00 ; p<0,001). McCay Klinik Değerlendirme Kriterlerine göre 37 kalçanın 36’sında (%97,3) Grade I mükemmel sonuç görüldü. Radyolojik olarak 37 kalçadan 29’u (%78,4) mükemmel, 8’i (%21,6) ise iyi sonuç olarak değerlendirildi. Otuz yedi kalçanın 2’sinde (%5,4) Grade I avasküler nekroz görüldü. Bu çalışmada 37 kalçanın 3’ünde (%8,1) sekonder asetabuler girişim ihtiyacı duyuldu. Sonuç: Gelişimsel kalça displazisi tedavisinde sınırlı açık redüksiyon Tönnis tip II ve III kalçalarda intraoperatif artrografi eşliğinde eklem kapsülü açılmadan, sadece ekstrakapsüler yapılar (addüktor longus ve iliopsoas tenotomileri) gevşetilerek, kalçanın yalnızca fleksiyon ve abduksiyonuyla stabil konsatrik redüksiyon sağlanan, majör girişim gerektirmeyen, teknik olarak kolay ve daha az deneyim gerektiren bir yöntem olduğuna inanmaktayız. Anahtar Sözcükler: Gelişimsel kalça displazisi, posteromedial sınırlı açık redüksiyon.
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    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, Huseyin
    Background: 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.