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Öğe Çocuklarda asetabulum kırığı: ender bir olgu sunumu(2013) Başaran, Serdar Hakan; Bilgili, Mustafa Gökhan; Kural, Cemal; Bayrak, Alkan; Avkan, Mustafa CevdetAsetabulum kırığı çocuklarda ve adolesanlarda oldukça nadir görülür. Bu kırık genellikle yüksekenerjili travma sonrası ortaya çıkar ve uzun dönem prognoz hastanın kırık anındaki yaşına,asetabulum Y kıkırdağının zedelenmesine ve deplasman miktarına göre değişir. Bu çalışmada yediyaşında kız çocuğunun yüksekten düşme sonucu gelişen, nondeplase iliak kanat kırığı ile birlikteolan sol asetabulum anterior duvar kırığının traksiyon tedavisinin sonuçları fonksiyonel veradyolojik olarak değerlendirildi.Öğe Efficiency and cost analysis of cell saver auto transfusion system in total knee arthroplasty(2014) Bilgili, Mustafa Gökhan; Erçın, Ersin; Peker, Gökhan; Kural, Cemal; Başaran, Serdar Hakan; Duramaz, Altug; Avkan, CevdetBackground: Blood loss and replacement is still a controversial is- sue in major orthopaedic surgery. Allogenic blood transfusion may cause legal problems and concerns regarding the transmission of transfusion-related diseases. Cellsaver Systems (CSS) were devel- oped 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 pro- cedure. Study Design: Retrospective comparative study. Methods: Those patients who were operated on by unilateral, ce- mented total knee arthroplasty (TKA) were retrospectively evalu- ated. 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 calcu- lated 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 allo- genic 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 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 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 Geriatrik hastalardaki intertrokanterik femur kırıklarının eksternal fiksatörle tedavisi(2013) Edıpoglu, Erdem; Bilgili, Mustafa Gökhan; Sarı, Cihangir; Başaran, Serdar Hakan; Kural, Cemal; Avkan, Mustafa CevdetAmaç: Bu çalışmada anestezi riski yüksek yaşlı hastalarda intertrokanterik kırıklar için eksternal fiksatörle osteosentezin sonuçları değerlendirildi. Gereç ve Yöntem: Kapalı intertrokanterik femur kırığı olan 68 hastaya (48 kadın, 20 erkek, ortalama yaş 77; dağılım 65-84) kapalı redüksiyon ve eksternal fiksatör uygulandı Kırıklar AO sınıflamasına göre değerlendirildi. A1.1, A1.2, A1.3 ve A2.1 tip kırıklar stabil (Grup 1), A2.2, A2.3, A3.1, A3.2 ve A3.3 tip kırıklar (Grup 2) instabil olarak sınıflandı. 1. Grupta 39, 2. Grupta 29 hasta olduğu görüldü. Hastaların tamamına, hafif sedasyonla kombine epidural anestezi uygulandı. Hastaların ortalama takip süresi 12 (9-18) aydı Tüm olgular AO tipi tübüler eksternal fiksatörle opere edildi. Hastaların operasyon ve hastanede yatış süresi, kaynama süresi, komplikasyon oranı ve hastaların ameliyat sonrası günlük aktivite düzeyleri araştırıldı. İstatistiksel analizler Mann-Whitney U-testi ile yapıldı. Bulgular: Ortalama ameliyat süresi 1. grupta 24 (17-60), 2. grupta 38 dakika (26-70) (p<0.001), ortalama hastanede kalış süresi 1. grupta 4 gün (2-10), 2. grupta 7 gün (3-13) (p<0.001), Ortalama kırık kaynama süresi 1. grupta 11.64 hafta (9-17), 2. grupta ise 13.9 hafta (11-18) olarak hesaplandı (p<0.001). 1. grupta 8 hastada yüzeyel, 3 hastada derin enfeksiyon görülürken, 2. grupta 10 hastada yüzeyel, 4 hastada ise derin enfeksiyon görüldü. 2. grupta 5 hastada ise varus deformitesi görüldü. Ortalama Barthel günlük aktivite skoru 1. grupta 14.2 (9-18), 2. Grupta 11.4 (4-14) olarak hesaplandı (p<0.01). Mortalite oranları açısından yapılan karşılaştırmada istatistiksel olarak anlamlı bir sonuç elde edilemedi. Sonuç: İntertrokanterik femur kırıklarında eksternal fiksatörle tespit, minimal invaziv, kanamasız, yumuşak dokulara ve kemiğe zarar vermeyen bir yöntem olması nedeniyle, yüksek riskli intertrokanterik kırıklı hastaların tedavisinde tercih edilecek yöntemlerden biridir. Ancak AO sınıflamasına göre instabil olarak değerlendirilen intertrokanterik femur kırıklarında kaynama zamanı daha uzun, varus pozisyonunda kaynama daha sık ve komplikasyon oranı daha yüksektir. Bu nedenlerden ötürü geriatrik hastalarda seçilmiş olgularda kullanılmalıdır.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(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 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.Öğe The treatment of intertrochanteric femur fractures in geriatric patients with external fixator(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2013) Edipoglu, Erdem; Bilgili, Mustafa Gokhan; Sari, Cihangir; Basaran, Serdar Hakan; Kural, Cemal; Avkan, Mustafa CevdetObjective: We evaluated the results of osteosynthesis with external fixation for intertrochanteric hip fractures in elderly patients with a high anesthesia risk. Material and Methods: Sixty-eight patients with closed intertrochanteric femur fractures (48 women, 20 men, mean age: 77 years; range between 65-84 years) were treated with an unilateral external fixator under epidural anesthesia combined with mild sedation. According to AO/OTA classification A1.1, A1.2, A1.3 and A2.1 types were accepted as stabil, (Group 1), A2.2, A2.3, A3.1, A3.2 and A3.3 type fractures (Group 2) were accepted as unstabil fracture types. In first group there were 39 patients and in the second group there was 29 patients. The mean follow up was 12 months (9 to 18). In all patients, an AO tubular external fixator was used. Operation time, hospitalization period, healing time, complication rate and postoperative activity level were evaluated. Statistical evaluation was done by Mann-Whitney U-test. Results: The mean operation time was 24 minutes (17-60) in the firstgroup and 38 minutes (26-70) in the second group (p<0.001). The mean hospitalization duration was 4 days (2-10) in the first group and 7 days (3-13) in the second group (p<0.001). The mean time for the union of the fracture was 11.64 (9-17) weeks in the first group and 13.9 weeks (11-18) in the second group (p<0.001). While 8 patients had superficial and 3 patients had deep infection in the first group, in the second group there were 10 patients with superficial and 4 with deep infection. In the second group, varus deformity was observed in 5 patients. The mean Barthel daily activity score was calculated as 14.2 (9-18) in the first group and 11.4 (4-14) in the second group (p<0.01). There was no statistically significant difference in the mortality ratios between two groups. Conclusion: Since fixation by external fixators for intertrochanteric femur fractures is minimally invasive, causes less bleeding and preserves soft tissues and bones, it is one of the preferred methods for the treatment of elderly patients with a high anesthesia risk. Nevertheless, for the intertrochanteric femur fractures that are unstable according to the AO classification, the union time is longer, union in the varus position is more often and the complication ratio is higher. Therefore it should be used for chosen cases among geriatric patients.
