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Öğe Intertrochanteric fractures in patients with lower limb amputation(E-Century Publishing Corporation, 2016) Ercin, E.; Baca, E.; Altun, S.; Bilgili, M.G.; Kural, C.; Basaran, S.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. © 2016, E-Century Publishing Corporation. All rights reserved.Öğe The measurement of tibial torsion by magnetic resonance imaging in children: the comparison of three different methods(Springer-Verlag France, 2015) Basaran, S.H.; Ercin, E.; Bayrak, A.; Cumen, H.; Bilgili, M.G.; Inci, E.; Avkan, M.C.Background: There is no consensus about the measurement techniques to determine the tibial torsion by using MRI. The primary research question of this study was to find out which MRI-based tibial torsion measurement method is more reliable and reproducible. Secondly, we compared tibial torsion values measured by three measurement methods in T1- and T2-weighted images. Methods: We retrospectively analyzed voluntary children performed MRI for determination of the lower limb torsional alignment after the surgical treatment between January 2013 and December 2013. Thirty-four extremities of 17 patients were included in the present study. The mean age of patients was 7.3 years (range 3–12 years). The transmalleolar, posterior intermalleolar and anterior talus angles were used for the measurement of tibial torsion. All tibial torsion measurements were calculated by three blinded observers in T1- and T2-weighted images, and these measurements were repeated blindly after 2 months. Results: All measured intra- and interobserver intra-class correlations were greater than 0.60. The best scores were achieved with the anterior talus angle. It was followed by the posterior malleolar angle and the intermalleolar angle, respectively. Furthermore, there were no statistically significant differences between tibial torsion values measured by each observer in T1- and T2-weighted images of each method. Conclusion: MRI-based tibial torsion measurements were reliable and reproducible for all three methods. But we think that the anterior talus angle and the posterior malleolar angle are easier and more successful in determination of the tibial torsion. Also, both T1- and T2-weighted images can be used successfully for this purpose. © 2015, Springer-Verlag France.Öğe A new joystick technique for unsuccessful closed reduction of supracondylar humeral fractures: minimum trauma(Springer-Verlag France, 2015) Basaran, S.H.; Ercin, E.; Bilgili, M.G.; Bayrak, A.; Cumen, H.; Avkan, M.C.Background: The purpose of this study was to compare operation duration, radiological and functional results of the open reduction with either posterior or lateral approach and closed reduction with joystick method in unsuccessful closed reduction of displaced (Gartland type III) supracondylar humeral fractures.; Methods: Between February 2010 and August 2011, 37 patients who were not obtained satisfactory reduction with classic closed reduction attempts for three times in operating room were included in this study. Patients were treated with three different surgical methods. Group I have 13 patients who had joystick and lateral K-wire-assisted closed reduction, group II have 12 patients who had open reduction by lateral approach, and group III have 12 patients who had open reduction by posterior approach. In final follow-up, AP and lateral radiographs of both elbows were taken and bilateral Baumann angles, lateral humerocapitellar angles, carrying angles, and elbow range of motion were measured. These angles and operation times compared between the groups. The functional and cosmetic outcome of surgery was evaluated by criteria of Flynn et al.; Results: There was no statistical significance difference between Baumann angles, lateral humerocapitellar angles, and carrying angles of fractured and uninjured sides in between three groups (respectively, p = 0.761, p = 0.354, p = 0.750). In group I, operation duration is shorter than the other groups. Functional scoring showed that in group I and group II, all patients have satisfactory results; however, in group III, three patients (25 %) had poor results. In the perspective of cosmetic results, all three groups have satisfactory results.; Conclusions: When classical closed reduction fail, lateral joystick and K-wire-assisted reduction is a useful way to make and maintain the reduction. Functional and radiological results are as good as lateral and posterior open approaches. Short operation time is an advantage. This method reduces the risk of complications due to repeated closed reduction and open reduction in unsuccessful closed reduction in pediatric supracondylar humeral fractures.; Level of evidence: Level III. © 2014, Springer-Verlag France.Öğe Risk factors for mortality in geriatric hip fractures: a compressional study of different surgical procedures in 785 consecutive patients(Springer-Verlag France, 2017) Ercin, E.; Bilgili, M.G.; Sari, C.; Basaran, S.H.; Tanriverdi, B.; Edipoglu, E.; Celen, K.M.Background: Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes. Methods: We included 785 patients age 65 years or older, with hip fractures. Operative treatment consisted of external fixation, internal fixation, total hip arthroplasty and hip hemiarthroplasty. Age, gender, type of fracture, type of surgery performed, American Society of Anesthesiology (ASA) grade, clinical comorbidities, anesthesia type, blood transfusion requirement, time to surgery, intensive care unit requirement, operation length and length of hospital stay and number of comorbidities were documented. Results: During the study period, 785 patients (262 male, 523 female) were included to study, Overall mortality rate was 37.2 % (292/785). Their age ranged between 65 and 100 years (mean 81). Surgery type Kaplan–Meier cumulative mortality curves suggested no significant difference between four different types of surgery groups (p = 0.064). Transfusion requirement was significantly lower in external fixation group comparing to other groups (p = 0.014). Cox regression analysis showed the number of comorbidities 2 and ? 3 (p = 0.0027, p = 0.015), transfusion requirement (p = 0.0001), ASA 4 (p = 0.016) to be significant predictors of mortality. Conclusions: Transfusion requirement, ASA grade 4 and having more than two comorbidities are risk factors for mortality in geriatric hip fractures. Type of surgical intervention and fracture type had similar mortality rates in our patient population. © 2016, Springer-Verlag France.
