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Öğe Fourth and fifth carpometacarpal fracture dislocations(Turkish Assoc Orthopaedics Traumatology, 2014) Kural, Cemal; Baaran, Serdar Hakan; Ercin, Ersin; Bayrak, Alkan; Bilgili, Mustafa Gokhan; Baca, EmreObjective: The aim of this study was to evaluate the mid-term results of patients with surgically treated 4th and 5th carpometacarpal (CMC) fracture dislocation. Methods: The study included 9 CMC dislocation patients (9 males; mean age: 31.2 years, range: 20 to 40 years) treated with open reduction and internal fixation between 2008 and 2012. Mean follow-up period was 19.4 months. Mean interval between trauma and operation was 10.7 (range: 3 to 35) days. Radiological evaluation was performed at the final follow-up. Hand grip power was measured using a hand dynamometer and the injured and uninjured sides were compared. Methods: There was a statistically significant difference compared to the injured side in hand dynamometer measurements (p<0.05). Three patients experienced pain during heavy labor. Among these cases, 2 had delayed diagnosis and 1 a comminuted CMC dislocation and was unable to return to his previous job. There were no recurrent dislocations or revision surgery due to complications. Conclusion: Early diagnosis and treatment of 4th and 5th CMC dislocation results in good anatomical and functional results. Delayed or incorrect diagnosis of this region causes severe radiological and functional problems. Detailed physical and radiological examination can prevent CMC dislocation from being overlooked.Öğe Fourth and fifth carpometacarpal fracture dislocations(2014) Kural, Cemal; Başaran, Serdar Hakan; Erçın, Ersin; Bayrak, Alkan; Bilgili, Mustafa Gökhan; Baca, EmreObjective: The aim of this study was to evaluate the mid-term results of patients with surgically treated 4th and 5th carpometacarpal (CMC) fracture dislocation. Methods: The study included 9 CMC dislocation patients (9 males; mean age: 31.2 years, range: 20 to 40 years) treated with open reduction and internal fixation between 2008 and 2012. Mean follow-up period was 19.4 months. Mean interval between trauma and operation was 10.7 (range: 3 to 35) days. Radiological evaluation was performed at the final follow-up. Hand grip power was measured using a hand dynamometer and the injured and uninjured sides were compared. Methods: There was a statistically significant difference compared to the injured side in hand dynamometer measurements (p<0.05). Three patients experienced pain during heavy labor. Among these cases, 2 had delayed diagnosis and 1 a comminuted CMC dislocation and was unable to return to his previous job. There were no recurrent dislocations or revision surgery due to complications. Conclusion: Early diagnosis and treatment of 4th and 5th CMC dislocation results in good anatomical and functional results. Delayed or incorrect diagnosis of this region causes severe radiological and functional problems. Detailed physical and radiological examination can prevent CMC dislocation from being overlooked.Öğe Intertrochanteric fractures in patients with lower limb amputation(E-Century Publishing Corp, 2016) Ercin, Ersin; Baca, Emre; Altun, Suleyman; Bilgili, Mustafa G.; Kural, Cemal; Basaran, Serdar H.Fracture of the residual limb in an amputee is uncommon. Intertrochanteric fractures of patients who had lower limb amputation have been studied only in several case reports; however clinical studies are lacking. We performed a retrospective clinical study to assess if these patients could return to their pre-fracture activity level after dynamic hip screw (DHS) fixation of their intertrochanteric fractures. Our hypothesis is that DHS fixation of intertrochanteric fractures in these patients would give good results with fracture union and could help to return to the previous activity level. We retrospectively reviewed data of the 12 patients (between the period of January 2006 and March 2013) who underwent DHS fixation of an intertrochanteric fracture on the ipsilateral side of a major lower limb amputation (above knee or below knee amputations). Age, gender, amputation level, amputation reason, time since amputation, mechanism of injury at the time of fracture, operation time, length of hospital stay, time to bone union and activity level were documented. Patient's activity level after one year of operation and union time were evaluated as primary outcomes. During the study period, 12 patients were included with seven (58.3%) male and five (41.7%) female. Mean age at the time of fracture was 57.6 years (range 48 to 72 years). All of the fractures were classified according to AO/OTA as 31A1. There were four patients (33.3%) with above knee and eight patients (66.7%) with below knee amputation. Mean time to bony union in twelve patients was 18 weeks (range 8 to 24 weeks). Ninety-two percent of these patients returned to pre-fracture activity level. There were no implant failure or nonunion at the minimum two-year follow-up period. DHS fixation of intertrochanteric hip fractures in patients with ipsilateral amputated limb provides good results of returning pre-fracture activity levels. Bone union time found to be similar in these patients when compared with patients with a normal limb.Öğe Medial mini-open versus percutaneous pin fixation for type iii supracondylar fractures in children(2016) Erçın, Ersin; Bilgili, Mustafa Gökhan; Baca, Emre; Başaran, Serdar Hakan; Bayrak, Alkan; Kural, Cemal; Avkan, Mustafa CevdetAMAÇ: Bu çalışmada, çocukluk çağında görülen suprakondiler humerus kırıklarında medial mini açık teknikle perkütan tekniği karşılaştırıldı, floros-kopi zamanı, cerrahi süre ve iyatrojenik ulnar sinir hasarı araştırıldı.GEREÇ VE YÖNTEM: 2011 ve 2013 yılları arasında ameliyat edilen 104 adet Gartland tip III suprakondiler humerus kırığı ileriye yönelik olarak incelendi. Birinci gruptaki (Grup A) 41 hastaya medial mini açık insizyonla medialden bir ve lateralden iki adet pin ile fiksasyonu yapıldı. İkinci gruptaki (Grup B) 63 hastaya tüm pinler perkütan yerleştirildi. Ortalama takip süresi Grup A'da 14.1±1.2 ay ve Grup B'de 14.6±2.1 aydır. Cerrahi sonrası hastalar sinir yaralanması açısından motor ve duyu muayeneleri yapıldı. Cerrahinin süresi, toplam floroskopi süresi, medial pin için floroskopi süresi, Baumann açısı, humerokapitallar açı, son taşıma açısı ve eklem hareket açıklığı değerlendirildi.BULGULAR: Duyu incelemesinde Grup A'da üç kötü ve bir orta sonuç, Grup B'de iki kötü ve bir orta sonuç elde edildi. İstatististiksel olarak fark saptanmadı. Gruplar arasında cerrahi süre ve toplam floroskopi süresi açısından fark saptanmadı. Medial mini açık yapılan grupta medial pin fiksas-yonu sırasında floroskopi süresi daha kısa saptandı.TARTIŞMA: Medial mini açık teknik ve perkütan tekniğin her ikisin dede iyatrojenik ulnar sinir yaralanma riski mevcuttur. Medial mini açık teknikte medial pin yerleştirme işlemi daha kısa süre floroskopi kullanımı açısından avantajlıdırÖğe Medial mini-open versus percutaneous pin fixation for type III supracondylar fractures in children(Turkish Assoc Trauma Emergency Surgery, 2016) Ercin, Ersin; Bilgili, Mustafa Gokhan; Baca, Emre; Basaran, Serdar Hakan; Bayrak, Alkan; Kural, Cemal; Avkan, Mustafa CevdetBACKGROUND: The present objective was to compare medial mini-open and percutaneous treatment of pediatric supracondylar fractures according to fluoroscopy time, duration of surgery, and iatrogenic ulnar nerve injury. METHODS: A total of 104 Gartland type III supracondylar humerus fractures were prospectively evaluated between 2011 and 2013. Patients were divided into 2 groups according to type of fixation. In Group A (41 patients), medial pin was inserted with mini-open incision with 2 lateral pins inserted percutaneously. In Group B (63 patients), all pins were inserted percutaneously. Mean follow-up time was 14.1 +/- 1.2 months in Group A, and 14.6 +/- 2.1 months in Group B. All patients were postoperatively evaluated for nerve injury with both motor and sensory function assessment. Length of surgery, total fluoroscopy time, fluoroscopy time for medial pin insertion, Baumann's angle, humeral capitellum angle, final carrying angle, and range of motion were recorded. RESULTS: Sensorial evaluation showed that Group A had 3 poor, and 1 fair results, and Group B had 2 poor, and 1 fair results. No statistically significant differences were observed, including no differences in either surgery or total fluoroscopy times between groups. However, fluoroscopy time during medial pin placement was significantly lower in the mini-open group. CONCLUSION: In conclusion, similar results of both techniques were observed, and both carry risk of iatrogenic ulnar nerve injury. Medial pin placement is easier and less demanding when used with mini-open technique.Öğe Peroneus quartus: prevalance and clinical importance(Springer, 2014) Bilgili, Mustafa Gokhan; Kaynak, Gokhan; Botanlioglu, Huseyin; Basaran, Serdar Hakan; Ercin, Ersin; Baca, Emre; Uzun, IbrahimThe most common variant muscle of the ankle, peroneus quartus muscle, is located in the lateral leg compartment. In literature there is ambiguous nomenclature of this muscle because of its different origin and insertion sides. It is related to many pathologic conditions in the lateral ankle compartment but also it can be used as a tendon graft for reconstructive procedures. We dissected 115 cadaver legs and investigated prevalence of peroneus quartus. We also present 2 year result of a patient who had torn superior peroneal retinaculum reconstructed with peroneus quartus tendon. The peroneus quartus muscle, with a number of different attachments, was present in 5.2 % (6/115) of the legs. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneus. Associated pathologies are longitudinal degeneration and tear in the tendon of peroneus brevis. There is no any association between the prevalence of peroneus quartus and the height of retrotrochlear eminence or presence of peroneal tubercule (p > 0.05). But there is strong relationship between peroneus brevis degeneration and peroneus quartus existence (p: 0.03). We also defined a new type of peroneus quartus with a bifurcated insertion around the peroneus brevis. In literature our case report is unique because we present a patient who has torn superior peroneal retinaculum which is reconstructed with peroneus quartus tendon with 2 year follow up. Peroneus quartus may lead to some pathologic conditions (pain, snapping, tear, synovitis, etc.) in the lateral ankle compartment but it may be used to reconstruct some pathologic conditions. Orthopaedics, anatomists and radiologists should be aware of this accessory tendon structure because of its clinical importance.Öğe Sural flap application in three cases with foot and tarsal soft tissue defect and review of literature(2016) Başaran, Serdar Hakan; Bilgili, Mustafa Gökhan; Tanrıverdı, Bülent; Erçın, Ersin; Baca, Emre; Kural, CemalAyak ve ayak bileği yumuşak doku defektli üç olguda sural flep uygulaması ve literatürün gözden geçirilmesiAyak ve ayak bileği yaralanmalarında subkutan dokunun ince olmasından dolayı tendon ve kemikler sıklıkla açıkta kalmaktadır. Bu defektlerin kapatılması için çeşitli metotlar tarif edilmiştir. Bu çalışmada travma sonrası ayak ve ayak bileğinde gelişen cilt ve cilt altı yumuşak doku kayıplarına bağlı açıkta kalan vital dokuların örtümünde ters akımlı nörokutan sural flep uyguladığımız üç hastanın dört ekstremitesinin tedavi sonuçlarını literatür eşliğinde değerlendirdik. Ters akımlı nörokutan sural flep kolay, etkinliği yüksek, donör saha morbiditesi ve komplikasyon oranları düşük olduğu için özellikle ayak bileği ve topuk bölgelerinde vital dokuların örtümünde tercih edilebilecek bir yöntemdir.Öğe Sural Flap Application in Three Cases with Foot and Tarsal Soft Tissue Defect and Review of Literature(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2016) Basaran, Serdar Hakan; Bilgili, Mustafa Gokhan; Tanriverdi, Bulent; Ercin, Ersin; Baca, Emre; Kural, CemalTendons and bones often remain uncovered due to thin subcutaneous tissues in foot and tarsal injuries. Several methods have been described to close these defects. In this study, we assessed the treatment results of the four extremities of the three patients to which we applied reverse-flow neurocutaneous sural flap in covering the vital tissues which remain uncovered based on post traumatic foot and tarsal cutaneous and subcutaneous soft tissue losses with literature. Reverse-flow neurocutaneous sural flap is a preferred method in covering vital tissues particularly in tarsal and heel areas because it is easy, highly effective with low donor site morbidity and complication rates.
