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Öğe Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty(Galenos Publ House, 2014) Bilgili, Mustafa Gokhan; Ercin, Ersin; Peker, Gokhan; Kural, Cemal; Basaran, Serdar Hakan; Duramaz, Altug; Avkan, CevdetBackground: Blood loss and replacement is still a controversial issue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were developed as an alternative to allogenic transfusion but CSS transfusion may cause coagulation, infection and haemodynamic instability. Aims: Our aim was to analyse the efficiency and cost analysis of a cell saver auto-transfusion system in the total knee arthroplasty procedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, cemented total knee arthroplasty (TKA) were retrospectively evaluated. Group 1 included 37 patients who were treated using the cell saver system, and Group 2 involved 39 patients who were treated by allogenic blood transfusion. The groups were compared in terms of preoperative haemoglobin and haematocrit levels, blood loss and transfusion amount, whether allogenic transfusion was made, degree of deformity, body mass index and cost. Results: No significant results could be obtained in the statistical comparisons made in terms of the demographic properties, deformity properties, preoperative laboratory values, transfusion amount and length of hospital stay of the groups. Average blood loss was calculated to be less in Group 1 (p<0.05) and cost was higher in Group 1 (p<0.05). Conclusion: Cell saver systems do not decrease the amount of allogenic blood transfusion and costs more. Therefore, the routine usage of the auto-transfusion systems is a controversial issue. Cell saver system usage does not affect allogenic blood transfusion incidence or allogenic blood transfusion volume. It was found that preoperative haemoglobin and body mass index rates may affect allogenic blood transfusion. Therefore, it is foreseen that auto-transfusion systems could be useful in patients with low haemoglobin level and body mass index.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 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 Isolated Ulnar Dorsal Cutaneous Nerve Herpes Zoster Reactivation(Slack Inc, 2013) Kayipmaz, Murat; Basaran, Serdar Hakan; Ercin, Ersin; Kural, CemalHerpes zoster is a viral disease presenting with vesicular eruptions that are usually preceded by pain and erythema. Herpes zoster can be seen in any dermatome of the body but most commonly appears in the thoracic region. Herpes zoster virus is typically transmitted from person to person through direct contact. The virus remains dormant in the dorsal ganglion of the affected individual throughout his or her lifetime. Herpes zoster reactivation commonly occurs in elderly people due to normal age-related decline in cell-mediated immunity. Postherpetic neuralgia is the most common complication and is defined as persistent pain or dysesthesia 1 month after resolution of the herpetic rash. This article describes a healthy 51-year-old woman who experienced a burning sensation and shooting pain along the ulnar dorsal cutaneous nerve. Ten days after the onset of pain, she developed cutaneous vesicular eruption and decreased light-touch sensation. Wrist and fourth and fifth finger range of motion were painful and slightly limited. Muscle strength was normal. Nerve conduction studies indicated an ulnar dorsal cutaneous nerve lesion. She was treated with anti-inflammatory and antibiotic drugs and the use of a short-arm resting splint. At 5-month follow-up, she reported no residual pain, numbness, or weakness. Herpes zoster in the upper extremity may be mistaken for entrapment neuropathies and diseases characterized by skin eruptions; ulnar nerve zoster reactivation is rarely seen. The authors report an uncommon ulnar dorsal cutaneous nerve herpes zoster reactivation. Clinicians should be aware of this virus during patients' initial evaluation.Öğe 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 The outcome and parents-based cosmetic satisfaction following fixation of paediatric supracondylar humerus fractures treated by closed method with or without small medial incision(Springer International Publishing Ag, 2016) Basaran, Serdar Hakan; Ercin, Ersin; Bayrak, Alkan; Bilgili, Mustafa Gokhan; Kizilkaya, Cemal; Dasar, Uygar; Avkan, Mustafa CevdetSupracondylar humerus fractures are common in children. Displaced fractures are usually treated with closed reduction and cross pin fixation. But, medial pinning may cause the ulnar nerve injury. The aim of this study was to compare the parents-based cosmetic satisfaction of the incision scars in children with displaced supracondylar humerus fractures treated by closed reduction and cross pin fixation with or without small medial incision. We retrospectively reviewed the medical records of 72 children with displaced supracondylar humerus fractures treated two different closed reduction and percutaneous pinning methods at our institution from January 2010 through December 2013. A group has 36 patients treated with small medial incision and crossed K-wires fixation after closed reduction. The other group has 36 patients treated with closed reduction and K-wires fixation. At the final follow-up, the patients were evaluated radiologically and clinically with Flynn's criteria. Furthermore, a visual analogue scale was used to determine of the parents-based cosmetic satisfaction score. All fractures healed without major complications at the final clinical and radiological assessment. Although, between the two groups did not differ in terms of Flynn cosmetic and functional outcomes, there were statistically significant differences between both groups according to the parents-based cosmetic satisfaction scores. The closed reduction and crossed pin fixation without small medial incision should be preferred first because of better the parents-based cosmetic satisfaction.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(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.Öğe The titanium elastic nailing in pediatric tibia fractures caused pedestrian versus motor vehicle accidents(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2016) Basaran, Serdar Hakan; Ercin, Ersin; Cumen, Huseyin; Dasar, Uygar; Bilgili, Mustafa Gokhan; Avkan, Mustafa CevdetObjective: The aim of our study was to investigate safety and effectiveness of titanium elastic nailing (TEN) in paediatric tibia shaft fractures caused by high-energy pedestrian versus motor vehicle accidents. Material and Methods: We conducted a retrospective review for children with unstable tibial shaft fractures treated with TEN caused by pedestrian versus motor vehicle accidents between June 2010 and December 2012. Eleven patients were included in study. Six patients (54.5%) were boys and five patients (45.5%) were girls. The mean age of the patients was 7.4 years (3-12). Five patients (45.5%) had closed and six patients (54.5%) had open fractures according to Gustilo-Anderson classification. At the follow-ups, patients were evaluated clinically and radiologically. Also, we investigated tibial torsion deformity by using MRI in our patients at last follow-up. Results: In all patients were obtained complete bone healing radiologically and clinically. In our patients, the average angulation was 1.5 degrees (0-3.9) on the coronal plane and the average angulation was 2.6 degrees (0-8.4) on the sagittal plane at the last follow-up. In four patients (36.4%) were found more than 10 mm the tibial length discrepancy. Also, we encountered more than 10 degrees the external tibial torsion deformity in three patients. Conclusion: TEN is a safe and effective treatment options in the high-energy pediatric open or closed tibia shaft fractures caused by pedestrian versus motor vehicle accidents. It should be kept in mind that these fractures also might develop in the tibial torsional deformity.Öğe Treatment and results in pediatric traumatic hip dislocation: Case series and review of the literature(Turkish Assoc Trauma Emergency Surgery, 2014) Basaran, Serdar Hakan; Bilgili, Mustafa Gokhan; Ercin, Ersin; Bayrak, Alkan; Ones, Halil Nadir; Avkan, Mustafa CevdetBACKGROUND: Six acute traumatic hip dislocations in pediatric patients were retrospectively analyzed. Types of dislocations, associated lesions, treatment methods, complications, and clinical and radiological outcomes were reviewed. METHODS: Six child patients treated due to traumatic hip dislocation between 2007 and 2011 in our clinic were included in the study. While five of the patients were male, one was female; the average age was 8 years and 8 months. The mean follow-up was 25.2 +/- 10 months. There were posterior dislocations in five cases and transepiphyseal fractured dislocation in one case. Four cases were treated by closed reduction while two cases were treated with open reduction method. RESULTS: In the last control of the patients, asymmetric widening in the hip joint was found due to osteochondral fracture in one patient and coxa magna occurred in one patient. Avascular necrosis developed in one case with transepiphyseal fractured dislocation. Harris hip score evaluation was found excellent in five cases and bad in the case with fractured dislocation. CONCLUSION: Traumatic hip dislocation is a rare condition. It should be treated with preferably closed method as soon as possible. Repetitive reduction trials should be avoided. Open reduction should be performed to recognize accompanying lesions after advanced radiologic examinations such as computerized tomography and magnetic resonance imaging.
