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    Anticipated decrease in surgeons: does orthopedic internship affect medical students career choice?
    (2020) Canbeyli, İbrahim Deniz; Çırpar, Meriç
    Aim: The aim of this study is to determine medical students’ career choices and to identify the effect of both demographic factors and the orthopedics residency education program on medical students’ career choices. Material and Method: This study was performed on a total of 154 medical students (92 females and 62 males; mean age 23.7±2.8) who attended Orthopedic internship program between 2018 and 2019 academic years. The students were subjected to a questionnaire twice on the first and last days of their internship program, which investigated distribution of selection of final year medical students’ career choices and factors that may play role on this selection. Results: Eighty-three (53.9%) students had changed their preferences and 72 (46.8%) had changed the order of preferences after Orthopedic internship program. The increase in the number of students who chose Orthopedics (p<0.001) and who placed Orthopedics in first order in their list of preferences (p=0.039) was statistically significant after the Orthopedic internship program. There was no significant difference between the female and male students in terms of placing surgical branches first in their list of preferences before (p=0.955) and after Orthopedic internship program (p=0.182). It was found that male students chose Orthopedics significantly more than females both before (p<0.001) and after (p<0.001) the internship. Conclusion: We demonstrated that early and active recruitment in surgery and operating theatre with positive support of faculty, residents and even operating room staff may increase interest in orthopedic surgery both for male and female medical students.
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    Comparison of functional outcomes in patients fixed with dynamic hip screw and proximal femur nail-anti-rotation in A1 and A2 type intertrochanteric femur fractures
    (2020) Sevinç, Hüseyin Fatih; Çırpar, Meriç; Canbeyli, İbrahim Deniz; Dağlar, Bülent; Oktaş, Birhan; Durusoy, Serhat
    BACKGROUND: We aimed to compare clinical and functional outcomes between patients treated with Dynamic hip screw (DHS) and Proximal Femoral Nail-Antirotation (PFN-A) implants. METHODS: This study included 122 patients (66 men [54.1%] and 56 women [45.9%]) who underwent surgery with DHS and PFN-A for an intertrochanteric femur fracture and had at least 12 months follow-up. Reduction assessment, femoral neck-shaft angle and tip-apex distance measurements were performed in early postoperative radiographs. On control visits in months 1, 3, 6 and 12, range of motion, thigh or hip pain, and Trendelenburg positivity were assessed in clinical examination and reduction assessment, femoral neck-shaft angle and tip-apex distance measurements were performed on radiographs after the union. Patients were assessed using Hip Harris Score after the union. RESULTS: Regardless of implant type used, mean tip-apex distance measured at the immediate postoperative period was 27.6 in patients with implant failure, whereas 21.6 in patients without, indicating a significant difference. Again, mean femoral neck-shaft angle measured at the immediate postoperative period was 123 degree in patients with implant failure, whereas 130 degree in those without, indicating a significant difference. It was found that the femoral neck-shaft angle was <128 degree in all patients with implant failure whereas it was >128 degree in 94% of patients without implant failure at immediate postoperative period. CONCLUSION: The findings regarding femur neck-shaft angle at the immediate postoperative period was <128 degree in all patients with implant failure and that it was ?128 degree in 94% of patients without implant failure emphasize the importance of anatomic restoration in femur neck-shaft angle during surgery. The finding that mean tip-apex distance was 27.6 mm in patients with implant failure and 21.6 mm in patients without implant failure indicates that the technique is as important as implant type selected for treatment success of the implantation.
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    Comparison of Kinesiotaping, Exercise and Subacromial Injection Treatments on Functionality and Life Quality in Shoulder Impingement Syndrome: A Randomized Controlled Study
    (SPRINGER HEIDELBERG, 2021) Vergili, Özge; Oktaş, Birhan; Canbeyli, İbrahim Deniz
    Purpose Disturbance of scapulohumeral rhythm has been shown to play a major role in subacromial impingement syndrome. Exercise, taping and subacromial injection are first ray conservative treatment modalities. We aimed to correct scapulohumeral rhythm with kinesio taping and exercise program via focusing on especially periscapular muscles not on glenohumeral structures to achieve scapulothorasic stabilization. Material and Methods Seventy five patients were divided into three groups randomly with different treatment modalities which are only exercise group (Group 1), kinesiotaping + exercise group (Group 2), and injection + exercise group (Group 3). Western Ontario Rotator Cuff Index (WORCI), Quick Disability of arm, shoulder, hand (Q-DASH), Constant- Murley Scores (CMS) were evaluated for each patient at the beginning, 15th and 60th days and compared in time and technique manner. Scores were analyzed statistically with One-way ANOVA and Chi-square tests. Results All the three groups had better results in short and long term follow ups as compared to initial admission. But in the second group 15th and 60th day results were superior to other groups significantly (p < 0,001). Conclusions Most of recent studies using kinesio taping were focused on mechanical correction of humerus which will be an impaired treatment to correct the main cause of impingement. Not only mechanical correction of periscapular muscles and also stabilization of scapulae will help to gain scapulohumeral rhythm.
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    Comparison of two medial epicondylectomy techniques in cubital tunnel syndrome
    (2017) Çırpar, Meriç; Özüak, Cem Seyfi; Oktaş, Birhan; Canbeyli, İbrahim Deniz
    Amaç: Bu çalışmada parsiyel medial epikondilektomi (PMe) ve distal medial epikondilektomi (DMe) teknikleri duyusal ve motor düzelme, fonksiyonel sonuçlar ve komplikasyonlar açısından karşılaştırıldı.Hastalar ve yöntemler: Çalışmaya toplam 59 kübital tünel sendromu hastası (37 erkek, 22 kadın, ort. yaş 42,3 yıl; dağılım 23-80 yıl) dahil edildi. Hastaların 30'una DMe, 29'una PMe uygulandı. Hastalar ameliyat öncesinde ve ameliyat sonrası üç, altı ve 12. aylarda Wilson Krout skorları, Semmes-Weinstein Monofilaman (SWM) testi ve kaba kavrama ve ince kavrama gücü ölçümleri ile değerlendirildi. Her iki grubun ameliyat öncesi ve sonrası grup içi ve gruplar arası sonuçları karşılaştırıldı.Bulgular: Ameliyat sonrası kontrollerde Wilson Krout skorları PMe'ye kıyasla DMe ile daha iyi idi. SWM testi skorlarındaki düzelme sadece DMe için istatistiksel olarak anlamlı idi. DMe grubunda kavrama, lateral ve terminal çimdikleme ölçümlerindeki düzelme ameliyat sonrası üçüncü ayda anlamlı idi. PMe grubunda bu ölçümler için anlamlı düzelme ameliyat sonrası altıncı ayda elde edildi. DMe ile görülen tek komplikasyon medial epikondil üzerinde ortaya çıkan hassasiyet idi. PMe grubunda dört hastada parestezinin eşlik ettiği ağrılı sinir subluksasyonu saptandı.Sonuç: PMe ile karşılaştırıldığında DMe daha tatmin edici sübjektif sonuçlar ortaya koymaktadır. DMe ile motor fonksiyonel iyileşme daha erken ortaya çıkmaktadır. DMe daha düşük komplikasyon oranlarına sahip görünmektedir.
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    Eklem İçi Uygulanan Trombositten Zengin Plazmanın (TZP) Etkisinin Diz Osteoartritinin Şiddeti ile İlişkisi
    (2020) Oktaş, Birhan; Canbeyli, İbrahim Deniz
    Amaç: Trombositten zengin plazma uygulamaları son dönemdediz osteoartritinde cerrahi dışı tedaviler arasında yer almayabaşlamıştır. Plasebo ve proloterapi gibi tedavilere üstünlüğügösterilmiştir. Ancak halen erken dönem ve geç dönem dizosteoartriti üzerine etkisinin değişiklik gösterip göstermediğitam net değildir. Biz bu çalışmamızda farklı evredeki dizosteoartriti olan hastalarda tek doz trombositten zengin plazmauygulamasının etkinliğini karşılaştırmayı amaçladık.Gereç ve Yöntemler: Tek dizine tek doz trombositten zenginplazma uygulanmış ve enjeksiyon öncesi Lysholm dizfonksiyonelliği skoru anketi doldurulmuş olan toplam 80 hastaçalışmaya dahil edildi. Bu hastaların daha önce çekilmişgrafileri üzerinden Kallgren-Lawrence osteoartrit sınıflamasıkullanılarak sınıflama yapıldı. Evre I ve II osteoartriti olanlar 1.gruba dahil edilirken, evre III ve IV osteoartriti olanlar 2. grubadahil edildi. Bu hastaların enjeksiyon öncesi ve sonrasındadoldurulmuş olan Lysholm diz fonksiyonelliği anketlerideğerlendirildi. Elde edilen veriler her iki grup arasında varyansanalizi kullanılarak (ANOVA) karşılaştırıldı.Bulgular: Her iki grubun Lysholm skorlarında enjeksiyonsonrası iyileşme mevcuttu. Her iki grupta da hem ağrı hemfonksiyonellik açısından daha iyi sonuçlar elde edildi.Enjeksiyon öncesi ve sonrası skorlardaki değişim elealındığında, birinci gruptaki değişim ikinci gruba göre anlamlıolarak daha fazlaydı. (p<0,05)Sonuç: Trombositten zengin plazma uygulaması erken evre dizosteoartritli hastalarda daha etkili idi. Tek doz uygulama hemağrının azaltılmasında hem de fonksiyonelliğin artırılmasındayeterli bulunmuştur. Ancak ileri evre osteoartritli hastalarda enaz 3 doz yapılması, cevap alınamadığında bir sonraki tedaviyöntemlerinin düşünülmesi gereklidir.
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    HIGH RATES OF REDUCTION IN CONSERVATIVE TREATMENT OF GERIATRIC DISTAL RADIUS FRACTURES
    (2020) Canbeyli, İbrahim Deniz; Oktaş, Birhan; Pehlivan, Ozan
    Objective: The aim of this study is to evaluate the earlyreduction results in conservative treatment of distal radialfractures in geriatric patients.Material and Methods: Patients aged over 60 years withdisplaced distal radius fractures who were treated withconservative treatment were included in the study. Follow-up Xraysof the patients at the 1st week were evaluated. Patients’ datawere obtained from hospital information management system.We evaluated the patient's age, sex, fracture side, the mechanismof injury, type of AO/OTA classification, loss of reduction, andtreatment methods.Results: One hundred and nineteen patients of 132 geriatricpatients with distal radius fracture were elligible for theinclusion criteria. 97.6% of patients with AO type 2R3Afracture were found to be within acceptable degrees of reductionin the 1st week of conservative treatment. Seven patients had aloss of reduction. Six had a high degree of dorsal angulation,and one had over 2mm step off. There was no significantdifference in terms of conservative treatment success betweenextra-articular fractures and partial and complete intra-articularfractures (p=0.584).Conclusion: We demonstrated that initial closed reduction andcast immobilization is an effective treatment method in themanagement of elderly patients with AO type 2R3A, 2R3B, and2R3C distal radius fractures.
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    LOW LOSS OF REDUCTION RATES IN PEDIATRIC DISTAL RADIUS FRACTURES WITH CONSERVATIVE TREATMENT
    (2020) Canbeyli, İbrahim Deniz; Baysan, Caner; Pehlivan, Ozan
    Objective: We aimed to assess the outcomes of conservativetreatment (closed reduction and cast immobilization) in themanagement of pediatric distal radius fractures.Material and Methods: A total of 138 pediatric patients aged 3to 16 years who sustained a distal radius fracture and underwentclosed reduction and cast immobilization in emergencydepartment were included in this retrospective study. The meanage of patients at the time of close reduction was 11.47 ± 3.60(range, 3-16) years. Age, gender, classification of fracture, side,and mechanism of injury were documented. In addition,displacement and angulation data were recorded from PACSintegrated hospital information management system. Weevaluated demographic characteristics of patients andradiographic loss of reduction.Results: A total of 50 patients were female, whereas 88 patientswere male. Thirty-one patients (22.5%) had loss of reduction.Colles fractures had significantly higher varus-valgus deformity(p<0.001; <0.001; <0.001 and <0.001, respectively) and APangulation (p=0.013; <0.001; <0.001 and <0.001, respectively)than SH type-2 and Torus/Buckle fractures at the first, second,4th, and 6th weeks follow-up views. There is no significantdifference in terms of varus-valgus deformity (p=0.160; 0.283;0.263 and 0.744, respectively) and AP angulation (p=0.996,0.943, 0.816 and 0.237, respectively) at each follow-up periodbetween female and male patients. We did not find anycorrelation between age and varus-valgus and AP angulation atthe follow-up views.Conclusion: We demonstrated that closed reduction and castimmobilization is an effective treatment method for colles, SHtype II, and Torus/Buckle distal radius fractures.
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    NİĞDE İLİ CİVARINDA YAŞAYAN SAĞLIKLI BİREYLERDE AYAK BİLEĞİ MORFOMETRİK ANALİZ ÖLÇÜMLERİ
    (Kırıkkale Üniversitesi, 2019) Sevgili, Ubeydullah; Sarı, Ahmet Sinan; Canbeyli, İbrahim Deniz
    Amaç: Ayak bileğiekleminin ve bu eklemi oluşturan kemik yüzeylerin morfolojik ölçümleri ayakbileği protez tasarımları için temel kılavuzdur. Çalışmamızın amacı Niğdebölgesinin sahip olduğu ayak bileği eklemi morfolojik ölçümlerini belirlemek veulusal ayak bileği protez tasarımları geliştirmeyi amaçlayan araştırmacılariçin bir veri kaynağı oluşturmaktır.Gereç ve Yöntemler: Niğde ÖmerHalisdemir Üniversitesi Tıp Fakültesi Hastanesi Ortopedi ve Travmatolojipolikliniğine 2 Ocak 2018-30 Haziran2018 tarihleri arasında başvuran ve herhangi bir sebepten dolayı ayak bileği ManyetikRezonans Görüntülemesi (MRG) çekilen hastalar geriye dönük olarak incelenmiştir.Bu görüntülerden ayak bileği boyut ölçümleri, ayak bileği en-boy oranları,distal tibia eğim ölçümleri ve komplikasyonla ilişkili anatomi ölçümleri ve 15indekse ait değerlendirmeler yapılmıştır.Bulgular: Çalışmamızda 100hastaya ait 100 MRG tetkiki üzerinde ölçümler tamamlanmıştır. Hastalardan 71’ikadın ve 29’u erkektir. Ortalama yaş tüm çalışma grubunda 43.75±14.80 (14-75),kadın cinsiyette 44.37±15.06 (14-75) ve erkek cinsiyette 42.24±14.28 (18-73)olarak bulunmuştur. Tibia ve talus boyut ölçüm parametreleri TiAL, MTiTh, SRTi,TiW, TaAL, TaW, MalW erkeklerde kadınlara nazaran anlamlı şekilde yüksekbulunmuştur. Ancak sırası ile tibia ve talus en-boy oranlarını ifade edenMTiTh/TiW ve TaAL/TaW parametreleri ve komplikasyon ile ilişkili anatomi ölçümparametreleri APG, MDV, MDA ve MalW/TiW cinsiyetler arasında anlamlı farklılıkgöstermemiştir.Sonuç: Bu sonuçlarerkeklerde kadınlara nazaran daha büyük boy protez bileşenleriningerekebileceğini ancak tek tip protez tasarımının her iki cinsiyette dekullanılabileceğini göstermektedir.
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    NİĞDE İLİ CİVARINDA YAŞAYAN SAĞLIKLI BİREYLERDE AYAK BİLEĞİ MORFOMETRİK ANALİZ ÖLÇÜMLERİ
    (2019) Sevgili, Ubeydullah; Sarı, Ahmet Sinan; Canbeyli, İbrahim Deniz
    Amaç: Ayak bileği ekleminin ve bu eklemi oluşturan kemikyüzeylerin morfolojik ölçümleri ayak bileği protez tasarımlarıiçin temel kılavuzdur. Çalışmamızın amacı Niğde bölgesininsahip olduğu ayak bileği eklemi morfolojik ölçümlerinibelirlemek ve ulusal ayak bileği protez tasarımları geliştirmeyiamaçlayan araştırmacılar için bir veri kaynağı oluşturmaktır.Gereç ve Yöntemler: Niğde Ömer Halisdemir ÜniversitesiTıp Fakültesi Hastanesi Ortopedi ve Travmatolojipolikliniğine 2 Ocak 2018-30 Haziran 2018 tarihleri arasındabaşvuran ve herhangi bir sebepten dolayı ayak bileği ManyetikRezonans Görüntülemesi (MRG) çekilen hastalar geriyedönük olarak incelenmiştir. Bu görüntülerden ayak bileğiboyut ölçümleri, ayak bileği en-boy oranları, distal tibia eğimölçümleri ve komplikasyonla ilişkili anatomi ölçümleri ve 15indekse ait değerlendirmeler yapılmıştır.Bulgular: Çalışmamızda 100 hastaya ait 100 MRG tetkikiüzerinde ölçümler tamamlanmıştır. Hastalardan 71’i kadın ve29’u erkektir. Ortalama yaş tüm çalışma grubunda43.75±14.80 (14-75), kadın cinsiyette 44.37±15.06 (14-75) veerkek cinsiyette 42.24±14.28 (18-73) olarak bulunmuştur.Tibia ve talus boyut ölçüm parametreleri TiAL, MTiTh, SRTi,TiW, TaAL, TaW, MalW erkeklerde kadınlara nazarananlamlı şekilde yüksek bulunmuştur. Ancak sırası ile tibia vetalus en-boy oranlarını ifade eden MTiTh/TiW ve TaAL/TaWparametreleri ve komplikasyon ile ilişkili anatomi ölçümparametreleri APG, MDV, MDA ve MalW/TiW cinsiyetlerarasında anlamlı farklılık göstermemiştir.Sonuç: Bu sonuçlar erkeklerde kadınlara nazaran daha büyükboy protez bileşenlerinin gerekebileceğini ancak tek tip proteztasarımının her iki cinsiyette de kullanılabileceğinigöstermektedir.
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    Pycnodysostosıs: Surgıcal Challenges Of Intramedullary Naılıng For Long Bone Fractures: A Case Report
    (2017) Canbeyli, İbrahim Deniz; Çırpar, Meriç; Oktaş, Birhan; Ökkeşim, Cüneyt Emre
    Pycnodysostosis, known as osteopetrosis acro-osteolytica, is a rare sclerotic bone disease with an autosomal recessive heritage pattern. Characteristic features of the disease are short stature, delayed closure of cranial sutures, partial or total dysplasia of the phalanges, obtuse mandibular angle, skeletal abnormalities and increased bone density. Type I collagen catabolism and bone resorption are defective in these patient due to lysosomal cysteine protease and cathepsin K enzyme defects resulting in dense and more brittle bones. Herein, we report a 45-year-old pycnodysostozis patient with a subtrochanteric transverse fracture of the left femur. We aim to reveal the difficulties encountered during intramedullary nailing of long bone fractures of patients with pycnodysostosis.
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    The effect of manual lymphatic drainage on the postoperative recovery process following total knee arthroplasty
    (2022) Vergili, Özge; Canbeyli, İbrahim Deniz; Oktaş, Birhan; Özsar, Barış Kemal; Keskin, Savaş
    Background: Knee joint has great importance on daily living activities thus gonarthrosis does affect quality of life of patients very dramatically. Total knee arthroplasty \r(TKA) is accepted as gold standard in order to cope with pain, deformity and instability especially in patients with gonarthrosis who are in terminal stage. Physical therapy \rand rehabilitation programs are known to increase the success of this surgical procedure. As edema around knee joint is one of the major postoperative complications, which \rprolong recovery process, it is important to use therapeutic modalities against this problem.\rObjective: In this study it was aimed to evaluate the effectiveness of manual lymphatic drainage (MLD) following TKA on edema, range of motion, pain, independence of \rdaily living activities, gait distance and knee functionality.\rMaterial and Method: 16 patients with TKA were divided into two groups while one of them is applied standard postoperative rehabilitation procedure (exercise therapy, \rcryotherapy and positioning) and the other group had MLD therapy on the second and fourth days of the postoperative process for thirty minutes and in one session during \rthe day in addition to standard protocol. On post-op 2nd, 4th, and 6th days, the volumetric changes were calculated based on a formula of Sitzia et al. for each 4 cm segment of \rthe lower extremity, active ROM and knee posture at rest were measured by a universal goniometer, pain by using visual analog scale (VAS), walking distance by calculating \rtotal walking distance in a day, independence level in daily living activities by using Functional independence measurement (FIM) scale. In addition, Lysholm knee score was \rcalculated on postoperative 15th day in order to evaluate functionality of knee joint.\rResults: At postoperative 2nd day, 4th day and 6th day, the mean of FIM (p=0.972, p=0.575, p=0.398, respectively), active ROM (p=0.288, p=0.522, p=0.622, respectively), \rknee posture (p=0.870, p=0.521, p=0.445, respectively), gait distance (p=1.000, p=0.258, p=0.113, respectively), volume of the operated lower extremity (p=0.451, p=0.384, \rp=0.268, respectively), VAS for pain daytime (p=0.192, p=0.488, p=0.506, respectively) and night (p=0.137, p=0.562, p=0.748, respectively) were similar in both MLD and \rnon-MLD groups. The mean of Lysholm score was 46.25±24.50 in MLD group and 61.12±17.70 in non-MLD group (p=0.186).\rConclusion: Although there is no significant difference between groups, the effectiveness of MLD can be showed in studies which will be performed with a larger sample size
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    The effect of the platelet-rich plasma on osteogenicpotential of the periosteum in an animal bone defect model
    (2021) Oktaş, Birhan; Çırpar, Meriç; Canbeyli, İbrahim Deniz; Şanlı, Elif; Bozdoğan, Önder
    Objectives: This study aims to investigate whether plasma-richplasma (PRP) enhances the osteogenic potential of periostealgrafts used to repair bone defects and maintains both histologicallyand biomechanically more durable bone tissue. Materials and methods: A standard bone defect was formed tothe left femurs of 54 Sprague-Dawley rats and three groups wereformed. In the first group (n=18), no periosteal repair was donefor bone defect. In the second group (n=18), periosteal graft tissuewas sutured to cover the defect entirely. In the third group (n=18),before periosteal repair, a 1 mL of PRP fibrin was applied into thebone defect. All femoral specimens were compared histologicallyat four and six weeks and biomechanically by three-pointbending test at six weeks after treatment. Results: In the PRP applied group, healing of the bone defectat four weeks was significantly better than the other groups interms of histological new bone formation (p<0.05). At six weeks,new bone formation in both of the periosteum preserved groupswas superior to the first group (p<0.05, for both). There was nostatistically significant difference between the second and thirdgroups at the end of the sixth week in the biomechanical analysis,although both groups were significantly stronger than the firstgroup (p<0.05). Conclusion: Stimulation of the periosteum with PRP applicationcauses early osteogenic differentiation of precursor cells.Although, at biomechanical basis, PRP application does notcreate any significant difference, in the recovery of the bonedefects at very early period, application of PRP may play a role toaccelerate fracture healing and to decrease nonunions.