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Öğe Can American Orthopaedic Foot and Ankle Society (AOFAS) score prevent unnecessary MRI in isolated ankle ligament injuries?(SAGE Publications Ltd, 2022) Kandemir, Veysel; Akar, Mehmet Sait; Yiğit, Şeyhmus; Durgut, Fatih; Atiç, Ramazan; Özkul, EminIntroduction and Objective: Ankle injuries are the most common musculoskeletal injuries. Its incidence is also high among sports injuries. Direct X-ray, ultrasound and MRI can be requested after the history and physical examination in the patient who presents with ankle ligament injury. Some classifications are used for requesting direct X-ray after ankle injury. Since clear limits are not specified in the literature for MRI, the rate of unnecessary MRI examinations is high. We argue that the decision can be made according to the AOFAS score to be checked before MR is requested, and thus unnecessary MR requests can be reduced. Material and Method: Ankle MRI images of patients who underwent ankle MRI due to ankle trauma between January 2018 and December 2020 were scanned. 328 patients who met the criteria were included in the study. Patients with AOFAS scores in their outpatient clinic records were identified. AOFAS scores of patients with at least one ligament injury and those with normal MR images were statistically compared. Sensitivity and specificity were determined for the AOFAS score using ROC analysis. Results: Patients with ligament damage as a result of MRI examination were 21.3% (n=70), and patients without any ligament damage were 78.7% (n=258). There was a statistically significant difference in terms of AOFAS between the group with ligament damage and the group without ligament damage (p< 0.05). In the ROC analysis, the AOFAS threshold value for MR request was determined as 80.5 (84.3% sensitivity and 72.3% specificity). Based on the determined threshold value, 73 patients who had unnecessary MRI would have been eliminated, thus reducing the number of MRIs by 42.6%. Conclusion: The AOFAS scores of patients with ligament damage were statistically significantly lower than those of patients without ligament pathology. Unnecessary MRI can be significantly prevented by using the AOFAS score in ankle traumas without bone fractures.Öğe Can formation of avascular necrosis really be prevented in Delbet type 2 femoral neck fractures?(Ulusal Travma ve Acil Cerrahi Derneği, 2022) Akar, Mehmet Sait; Yiğit, ŞeyhmusBACKGROUND: Fractures of proximal femur are rarely seen in childhood. These fractures can result in serious complications such as avascular necrosis (AVN), coxa vara, and early closure of the femoral epiphysis. The aim of this study is to investigate retrospectively the Delbet type 2 fractures that are commonly seen and has high rates of AVN. METHODS: Forty-two patients whose Delbet type 2 fractures were treated in our hospital between January 2009 and June 2018 were analyzed. The patients’ mechanism of fracture formation, displacement of the fracture, presence of accompanying injuries, tim- ing of surgery, open or closed reduction, whether the screws cross the epiphyseal growth plate epiphyseal line, and AVN data were analyzed retrospectively. RESULTS: Of the 42 screened patients, 34 patients with complete follow-up graphs and files were included in the study. The mean age of the patients was 11.02 years (1–17 years old), and the mean follow-up time was 40.82 months (range 24 to 98 months). When the follow-up radiographs of the patients were examined, it was found that AVN in 9 patients (26.5%), coxa vara in 2 patients (5.9%), and non-union in 1 patient (2.9%). The AVN rate was significantly higher in patients with high-energy injuries and high fracture dis- placement at baseline (p=0.034 and p=0.047, respectively). CONCLUSION: According to our findings in Delbet type 2 fractures, other than the severity of the trauma and the initial displace- ment of the fracture, factors related to the treatment process do not have a significant effect on the development of AVN. Age was not determined as a risk factor for the development of AVN in these patients.Öğe Changes in composition of adamts-5 and cd-68 in the knee joint synovial fluid cells of meniscal tears patients an immunohistochemical study(Universidad de la Frontera, 2020) Yiğit, Şeyhmus; Ekinci, CenapMeniscus tear is an important injury affecting the quality of life. This work is aimed to investigate the activity of CD68 and ADAMTS-5 in cells in synovial fluid in male and female patients with meniscal tear. In this study ,18 male and 22 female patients with meniscal tears were included. Local pain sensation during patients' physical examination, swelling, performing daily activities and difficulty in running-walking complaints were determined. 5 cc synovial fluids were aspirated from the lateral suprapatellar pouch part of the knees with meniscal pain. After routine histological follow-up of the samples, they were embedded in paraffin and sectioned with microtome and 5 micrometer thickness. CD68 and ADAMTS-5 primary antibodies were used for immunohistochemical analysis. Sections were taken and evaluated with a stylish microscope. The distribution of blood cells after meniscus tear was higher in female patients than in male patients. CD68 distribution in female patients appeared higher than in male patients. CD68 expression was high in macrophage cell cytoplasm. ADAMTS-5 expression was higher in female patients in degenerative cells and apoptotic cells. ADAMTS-5 is an important metallo-protein involved in the development of apoptotic signal and extracellular matrix synthesis in patients with ADAMTS-5 meniscus tear, and it may be an important criterion for the treatment developed after injury. CD68 and ADAMTS-5 activity was thought to be one of the important signal pathways that can be identified in the treatment of meniscus tear.Öğe Comparative outcomes of early, elective, and delayed treatment for lateral condyle fracture of the humerus in children: A retrospective study from a single center in Turkey (2013-2021)(2024) Ulus, Sait Anıl; Yiğit, Şeyhmus; Özkul, EminBackground: Lateral condyle fracture of the humerus in children should be diagnosed and treated quickly to avoid the complications of malunion and varus deformity of the elbow. Worldwide, pediatric orthopedic departments experienced delays in patient diagnosis and treatment during the COVID-19 pandemic. This retrospective study from a single center in Turkey aimed to compare outcomes from early treatment, elective treatment, and delayed treatment in 140 children with lateral condyle fracture of the humerus between 2013 and 2021. Material/Methods: In the study, 140 patients with Milch type 2 fractures were included. Patients underwent fixation with K-wires or screws after open or closed reduction. Data collected included age, sex, trauma details, surgery timing, operating conditions, perioperative issues, and rehabilitation outcomes. Fracture union and complications were monitored through clinical examinations and X-rays. Clinical outcomes were evaluated using the Mayo Elbow Performance Score (MEPS). Results: There were 58 patients in the early group, 52 in the elective group, and 30 in the delayed group. Surgery durations varied among the groups (P=0.000). The early and delayed groups as well as the early and elective groups had significantly different incision sizes (P=0.000 for both). The early and delayed groups and the early and elective groups had significantly different MEPS scores (P=0.002 and P=0.011, respectively). Conclusions: In patients with late-presenting lateral condyle fractures, although complications increase, surgical treatment does not yield worse outcomes. Standardization of fracture management should be maintained during periods such as COVID-19.Öğe Fixation of forearm fractures with intramedullary k-wire or elastic nail by fluoroscopy in children and radiation exposure(2020) Yiğit, ŞeyhmusAim: To show midterm results and compare the two methods utilized in pediatric forearm fractures fixation and the risks of radiation.Material and Methods: We conducted retrospective studies of 62 children and adolescent between the age of 6 to 16 years who were exposed to traumatic forearm fractures and treated with methods of fixation mini open reduction and intramedullary K-wire pinning(group 1) and close reduction and intramedullary elastic nailing(group 2). Patient data included age, gender, the mechanismsof injury, fluoroscopic screening time, dose area product (DAP) value, union time, duration of hospitalization, and complications.Results: There was a significant difference in radiation exposure and radiation-related cancer risk in group 2 (P<0.001). There was no significant difference between the two groups in the first year of surgery compared to union (p: 0.49), complications and Price CT et al criteria (p: 0,57).Conclusions: If the surgeon's experience is insufficient, the duration of close reduction and intramedullary nailing operation time and the number of fluoroscopic imaging will increase. This will increase the radiation exposure and the risks associated with radiation for the patient and surgical team. In our opinion, surgeons who do not have enough surgical experience should use open reduction technique to avoid using too much fluoroscopic imaging. Orthopedics surgeons must protect himself, his personnel and the patientfrom radiation exposure.Öğe Graft application and dexamethasone treatment influences new bone formation in rat tibial bone defects(Universidad de la Frontera, 2020) Yiğit, Şeyhmus; Deveci, EnginThe objective of this study were bone defect complications that occur due to traumas or infections. Bone grafts are required to provide support, fill gaps and improve biological repair in skeletal damage. Dexamethasone plays role in calcium signaling modulation and used in diseases. Aim of this study was to evaluate osteonectin and osteopontin expressions in new bone development after dexamethasone application on tibial bone defects. Rats were divided into defect, defect+graft and defect+graft+dexamethasone treated groups. Tibial bone defect created, and rats were kept immobile for 28 days. Alloplastic material was placed in defect area in second and group third groups. 2.5 mg/kg Dex and normal saline were injected to dexamethasone and defect groups twice a week for 56 days. Inflammation and congestion were increased in defect and defect+graft groups. Defect+graft+dexamethasone group; increased number of osteoblast and osteocyte cells, dense bone matrix, formation of new bone trabeculae was observed. Defect+graft group; osteonectin expression in graft regions, osteoblast cells, some connective tissue cells and fibers were seen whereas in defect+graft+dexamethasone group; osteopontin expression in osteoblast and osteocyte cells of new bone trabeculae were observed. Dexamethasone may lead to formation of new bone trabeculae into the graft material resulting in increased osteoconduction and osteoinductive effect for differentiation of osteon. © 2020, Universidad de la Frontera. All rights reserved.Öğe Periprosthetic infection risks and predictive value of c-reactive protein / albumin ratio for total joint arthroplasty(Mattioli 1885, 2021) Yiğit, Şeyhmus; Akar, Mehmet Sait; Şahin, Mehmet Akif; Arslan, HüseyinBackground and aim: There are no gold standard markers to estimate the risk of developing periprosthetic infections. Our aim is to compare the risks of periprosthetic infection in patients with THA and THA and to investigate the predictive significance of the CRP / albumin ratio. Methods: This is a retrospective study containing data from 241 osteoarthritis patients and 19 patients with periprosthetic infections who underwent TKA and THA in our hospital from January 2014 to January 2019.12 risk factors(CRP/ albumin, albumin, CRP, age, gender, BMI, DM, ASA, nasal culture, urine culture, hospital stay, operation time) were analyzed. Results: In the binary logistic regression model and multivariate regression analysis, the rate of CRP / albumin was 17.161 times higher than the patients with ?0.16 cut-off value. (CRP / albumin ratio (odds ratio (OR) = 17.16, 95% CI: 1.55-189.03, P: 0.02). High BMI increased the risk of periprosthetic infection 1.3 times. Nasal bacterial colonization (OR = 0.99, 95% CI: 0.868-1.38, P: 0.7) and bacterium in urine (OR = 0.502, 95% CI: 0.07-3.598, P: 0.703) did not pose a significant risk for periprosthetic infection. Conclusion: According to our findings, the CRP / albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. CRP / albumin ratio is a cheap and easy to apply marker. Routine urine and nasal bacteria screening is not required before total joint arthroplasty.Öğe Periprosthetic infection risks and predictive value of HbA1c/albumin ratio for total joint arthroplasty in patients with diabetes mellitus(Verduci Editore s.r.l, 2023) Yiğit, Şeyhmus; Akar, Mehmet SaitOBJECTIVE: There are no gold standard markers to estimate the risk of developing periprosthetic infections in diabetes mellitus. Our aim is to compare the risks of periprosthetic infection in patients undergoing total joint arthroplasty with diabetes mellitus and to investigate the predictive significance of the HbA1c/ albumin ratio. PATIENTS AND METHODS: Between January 2012 and January 2020, 690 patients who underwent total joint arthroplasty were analysed. 264 diabetic patients were included in the study. 104 of them had periprosthetic infection. 8 risk factors (Hba1c/albumin, HbA1c, albumin, age, BMI, ASA, hospital stay, operation time) were analysed. RESULTS: The rate of HbA1c/albumin was 14.6 times higher than the patients with ≤2.37 cut-off value. (Hba1c/albumin ratio (odds ratio (OR) = 14.6, 95% CI: 3.18-67.1, p: 0.01). HbA1c (OR = 2.6, 95% CI: 1.529-4.754, p: 0.001), BMI (OR = 1.6, 95% CI: 1.168-2.199, p<0.003), DM (OR = 0.365, 95% CI: 0.135-0.987, p: 0.04) and glucose (OR = 1.016, 95% CI: 1.004-1.029, p: 0.011) were risk factures for periprosthetic infection. Albumin (OR = 0.503, 95% CI: 0.109-2.314, p: 0.378) did not pose a significant risk for periprosthetic infection. CONCLUSIONS: According to our findings, the HbA1c/albumin ratio has a more prognostic capacity than other risks in determining the risk of periprosthetic infection for total joint arthroplasty. HbA1c/albumin ratio is a cheap and easyto-apply marker. Patients with an HbA1c/albumin cut-off ratio above 2.37 mg/dl in total joint arthroplasty should be followed more closely for the risk of periprosthetic infection.Öğe Predictive factors for the development of Gartland type IV supracondylar humerus fractures: a prospective clinical study(Aves Yayıncılık, 2022) Yiğit, Şeyhmus; Aslan, Rıdvan; Arslan, Hüseyin; Özkul, Emin; Atiç, Ramazan; Akar, Mehmet SaitObjective: This study aimed to identify the preoperative predictive factors for the development of Gartland type IV supracondylar humerus fracture based on the patient characteristic, fracture mechanism, and preoperative radiographic fracture characteristics. Methods: This prospective study included the data of 120 patients with Gartland type III and IV supracondylar humerus fractures treated in a single center from 2020 to 2021. Patients’ age, gender, height/weight percentile values, injury mechanisms, the proximity of fracture fragment to the skin (i.e., dimple sign), and time from trauma to surgical treatment were recorded. In the preoperative radiographs, the degree of extension or flexion deformity between fracture fragments in the sagittal plane, varus/valgus angulation between fracture fragments in the coronal plane, the amount of translation (medial or lateral) in the coronal plane, and the amount of osseous apposition between fracture fragments in the coronal plane were evaluated. With the authors’ consensus, the patients were divided into 2 groups based on the presence of multidirectional instability during the intraoperative reduction: group 1 (Gartland type III; 99 patients) and group 2 (Gartland type IV; 21 patients). Fixation of the fractures was then completed. Results: Significant differences were observed between groups in the valgus/varus angle and amount of osseous apposition (P < .001). Although no significant difference was found in terms of translation amount between the groups (P=.088), there was a significant correlation with medial translation in type IV fractures (P < .001). The correlation between the results and the groups was checked with Spearman’s test. Medial translation (r=0.352), varus or valgus angulation (r=0.616), and osseous apposition (r=0.433) exhibited a positive correlation. The probability of type IV fracture was modeled for the preoperative parameters using binary logistic regression. The regression analysis showed that the diagnosis of type IV supracondylar fractures could be predicted, if varus or valgus angulation was more than 25.5° (81% sensitivity, 85% specificity, odds ratio=1.725; 95% CI=1.170-2.541, P=.001, r=0.616) and if the amount of osseous apposition was more than 9.5 mm (85% sensitivity, 81% specificity, odds ratio=1.471; 95% CI=0.714-3.029, P=.001, r=0.433) in the preoperative radiographs. There was also a significant correlation between medial translation (varus angulation) (P < .001, r=0.352), age (P=.019, r=0.255), and patients with more than 90 height/weight percentile values (P < .001, r=0.508) with the possibility to have Gartland type IV fractures. Conclusion: This study has found some preoperative factors that may be relevant for type IV Gartland fractures. Height/weight values greater than the 90 percentile, varus or valgus angulation greater than 25.5°, bone apposition values greater than 9.5mm, medial translation values greater than 11mm, and older than eight years patients type IV fractures were more common in such patients. If surgeons can more accurately diagnose a Gartland type IV fracture preoperatively, the surgeon can more accurately inform the patient and plan better treatment.Öğe Surgical treatment results of fibrous dysplasia and effects of using grafts(Aves, 2021) Akar, Mehmet Sait; Yiğit, ŞeyhmusBACKGROUND/AIMS Fibrous dysplasia (FD) is a skeletal system disorder characterized by replacement of normal bone and bone marrow with fibro-osseous tissue and proliferation of immature osteogenic cells. There is no consensus regarding the timing of orthopedic surgery, the choice of implants, and use of grafts owing to its variable clinical appearance and wider age range. This study aimed to contribute to the literature by performing a retrospective study involving patients with FD. MATERIAL and METHODS This retrospective study included 41 patients with FD. Patients were evaluated for the first-visit and follow-up graphs. Patients were examined for the effects of intramedullary nailing and plate fixation. The use of grafts during surgery was noted and examined in terms of increase in deformity during the operation time and follow-up. RESULTS Surgical intervention was performed on 45 bone lesions in 41 patients. Plate was used in 7 patients with pathological fracture, and intramedullary nail was used in 19 patients. There was a significant difference between the groups (P=.011). No deformity was detected in 16 of the 26 patients with pathological fractures. In 20 patients in whom grafts were used, cortical thickening was observed on the basis of the preoperative graphs. Graft survival rate was reported to be 83.3%. CONCLUSION The presence of pathological fractures affects the choice of implants by surgeons. Cortical thinning is the most important parameter than deformity in terms of the risk assessment of pathological fractures for surgical planning. Allograft survival rate is high for 4 years, on average. Cite this article as: Akar MS, Yiğit Ş. Surgical Treatment Results of Fibrous Dysplasia and Effects of Using Grafts. Cyprus J Med Sci 2020; 6(1): 34-8.Öğe A technical trick for extracting a stingray spine from hand: a case report(Türk Ortopedi ve Travmatoloji Derneği, 2022) Akar, Mehmet Sait; Ulus, Sait Anıl; Durgut, Fatih; Yiğit, ŞeyhmusInjuries from stingray fish are among the most common fish stings, and their frequency is increasing with the increase in global tourism. It most commonly causes injuries to the extremities and causes morbidity if not treated appropriately. Less commonly, life-threatening injuries can be observed due to injuries in the thorax and abdomen and damage to large vessels and vital organs. In addition to severe pain, tissue necrosis, and secondary infection after injury, systemic symptoms may occur. Since these injuries can occur in both fresh and salt water, it is possible to encounter such a case at any time. Flat spines are sharp, with backward barbs or serrations that make them difficult to extract once they penetrate tissue. After first aid, surgical extraction of the stingray spine with minimal damage is essential in addition to local and systemic treatments. In the literature, there are studies on envenomation and other systemic findings after stingray spine injuries, but few publications are available on the stingray spine extracted technique after injury. This case report presents a new and helpful technique for stingray spine extraction.Öğe THE OPERATIVE TREATMENT OUTCOMES OF CHRONIC HINDFOOT PAIN WITH POSTERIOR ANKLE ENDOSCOPY(Rojan GÜMÜŞ, 2021) Yiğit, Şeyhmus; Yıldırım, AzadObjectives: The purpose of this study was to assess the outcome of hindfoot endoscopy and to show the availability of this technique by short- to mid-term outcomes on 27 consecutive patients. Methods: A case series of 27 patients, mean age 19-63(mean37.6) ,15 man and 12 woman, diagnosed and treated for chronic hindfoot pain were included for the study between 2010-2016 All these patients were initially treated conservatively. If conservative treatment is insufficient to alleviate symptoms, posterior ankle endoscopy is performed. Patient data included age, gender, the location and the pattern of foot, follow-up, the time delay from symptom onset to operation, surgeries, the length of hospitalization, the pain scores (AOFAS, VAS), time to return to work, and complications. Results: The indications for 27 patients were posterior ankle impingement syndrome (n:8), isolated flexor hallucis longus (FHL) tenosynovitis (n:7),loose body (n:2),subtalar joint arthrosis (n:3),achyl tendinitis (n:1) and peritendinitis(n:6). Symptom duration until operation was 6-22 months (mean 13.2 months). The patients who underwent arthroscopic surgery resumed to their work a mean time of 2-6 months (mean 2.5 months) after the surgery. All patients returned to their previous lives without any limitation or recurrence. Mean follow-up 46.5 months (21-96 months). AOFAS score was preoperative 44-63 (mean 51.4) and postoperative was 92-100 (mean 96.37). The VAS score was preop 5-8 (mean 6.4) and postop 0-2 (mean 0.62). One patient had a partial arterial injury that was repaired, and four patients had mild joint stiffness. Conclusion: Functional and clinical evaluations following hindfoot endoscopy revealed that all patients were very satisfied. Thus, posterior ankle endoscopy is an effective, elegant and rewarding treatment method in the case of continuing chronic hindfoot pain after failed non-surgical treatment modalities.Öğe Unrecognized volar subluxation of the metacarpophalangeal joint of the thumb: A case report(Mattioli 1885, 2021) Yiğit, Şeyhmus; Gürcan, SerkanWe present a 30-year-old female patient with a volar subluxation of the metacarpophalangeal joint of the thumb. Dislocation of the metacarpophalangeal joint is rare; volar subluxation is much more rare. Open reduction was performed through a dorsal incision because of the soft tissue interposition. Ultimately, doctors in the emergency department should pay attention to volar MCPJ subluxation and it is important to assess collateral ligament stability after closed reduction. (www.actabiomedica.it).Öğe Which one affects more to clinical and radiological outcomes in pediatric calcaneus fractures? Is the severity of trauma or the applied surgical technique?(Dicle Üniversitesi Tıp Fakültesi, 2021) Yiğit, Şeyhmus; Özkul, Emin; Atiç, Ramazan; Kandemir, Veysel; Turgut, Ali; Yıldırım, AzadObjective: The aim of our study is to evaluate the clinical and radiographic results of pediatric calcaneus fractures treated in our hospital in terms of age, treatment techniques and trauma severity and to compare with the literature Methods: This is a retrospective study conducted on 22 pediatric patients (28 calcaneus fractures) treated with surgery for calcaneus fractures in our hospital from March 2005 to January 2020. There were seven patients (patients between 3 and 6 years old) in group 1 and 15 patients (between 7 and 16 years old) in group 2. Results: 17 fractures were treated with the CRPP technique, 11 fractures were treated with the ORIF technique. The mean age was 11.4 months (range 3–16). Average follow-up time 81.54 months (range 12-156). There is a significant relationship between age and CRPP(p:0.000), but not with ORIF(p:0.10). The most important result of our study is that there is no significant difference between AOFAS scores with CRPP and ORIF techniques (P: 0.167 and p: 0.20, respectively). The second most important result in our study was that there was a significant relationship between Essex Lopresti and Sanders classification to AOFAS score(p: 0.013 in both.). Conclusion : Immature calcaneus fractures are rare, and those without anatomical reduction, as in adults, have poor results. In pediatric calcaneus fractures, fragmentation due to the severity of trauma, cartilage damage, cancellous bone loss and their consequence may cause circulatory disorders between the fracture parts. As a result, post-traumatic arthritis may develop even if anatomical reduction is made. The most important thing that determines the result in pediatric calcaneus fractures is how high energy the fracture occurs rather than the surgical technique to be chosen.
