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Öğe Bilateral traumatic patella fracture: a case report(Turkish Joint Diseases Foundation, 2011) Cirpar, Meric; Turker, Mehmet; Aslan, Arif; Yalcinozan, MehmetPatellar fractures are uncommon injuries and account for approximately 1% of all fractures. In this article, a 35-year-old male patient who sustained a collision deceleration accident with bilateral comminuted transverse patellar fractures is presented. For this patient, open reduction and internal fixation with tension band technique, using two Kirschner wires and cerclage wire was applied for both fractures. At the first postoperative day, isometric quadriceps and active range of motion exercises were begun and the patient was allowed to walk full weight bearing with two crutches while both extremities were immobilized in a hinged brace allowing maximum 30 degrees of flexion. At postoperative fourth week brace immobilization was terminated. However, the patient was advised to use crutches for two weeks more to prevent any complications that may arise during walking because of the bilaterally of the injury. At six weeks solid union was achieved. During the last visit at postoperative second year, the patient had no complaints and the range of motion was full. In this paper a case of bilateral patella fractures is presented as a consequence of a dashboard injury, and the pathomechanical and therapeutical aspects of such an injury is discussed.Öğe Clamp fixation to prevent unfolding of a suture knot decreases tensile strength of polypropylene sutures(Springer, 2012) Turker, Mehmet; Yalcinozan, Mehmet; Cirpar, Meric; Cetik, Ozgur; Kalaycioglu, BarisPurpose Although sutures evolved in last decade and the product spectrum broadened largely, they can be still classified into two: monofilament and multifilament. Sutures are the mainstay of orthopedic procedures like fascial closures, tendon repairs or tenodesis. In every repair, a suture loop is created. This suture loop is prone to failure due to suture elongation, knot slip and suture breakage. As the knot is the stress riser in a suture loop, the majority of acute loop failure occurs just adjacent to the knot. Monofilament sutures have higher bending stiffness and tendency to untie than multifilament sutures. The first throw of monofilament sutures have tendency to untie, which decrease loop tension and result in loss of achieved tissue approximation. Methods Although a common practice is to fix the first throw via a clamp before the locking one is tied, it can be hypothesized that a potential deforming effect can lead to a decrease in ultimate failure load of a monofilament suture loop. Results Fixing the first throw significantly reduced the ultimate failure load of monofilament nonabsorbable polypropylene sutures (Prolene) (62.2 +/- 8 N vs. 72.7 +/- 9 N, p = 0.019). The ultimate failure load achieved by monofilament sutures Polyglyconate (Maxon) and Nylon (Ethilon) and braided absorbable Polyglactin (Vicryl) were not affected by fixing the first throw. Conclusion Under microscopic examination, polypropylene sutures were found to be deformed by clamp fixation, while the others were not. Polypropylene sutures can be easily damaged when it is fixed by a clamp during knot tying. Presented data demonstrated that in real surgical situations clamp fixation of polypropylene knots can damage the suture loop and carry the risk of acute failure of repair site during early rehabilitation.Öğe Comparison of bench-top simulation versus traditional training models in diagnostic arthroscopic skills training(Turkish Joint Diseases Foundation, 2018) Canbeyli, Ibrahim Deniz; Cirpar, Meric; Oktas, Birhan; Keskinkilic, Seyyid IsaObjectives: This study aims to compare the efficacy of existing training models for acquisition of arthroscopic skills and to investigate the most effective training method or combination of methods for residents. Materials and methods: A total of 100 fifth-year students from medical school (40 males, 60 females; mean age 23.7 years; range, 22 to 33 years) volunteered to participate in the study and were randomly divided into five education groups (E1-5): group E1 (trained on bench-top simulator), group E2 (read surgical technique), group E3 (read surgical technique and watched surgical video), group E4 (watched surgical video only), and group E5 (control group). After completion of the pre-training, each student was individually asked to perform an arthroscopy practice. A checklist containing the tasks to be performed w as gig en to students and students were asked to complete the tasks on the checklist in five minutes. Results: In group E1, the mean rate of successful achievement of tasks was significantly higher than other groups in both knee and shoulder arthroscopy models. Rate of each task was statistically similar for groups E2, E3, E4 and E5. In group E1, mean durations for completion of tasks in both arthroscopy models were significantly shorter than other groups. There was no statistically significant difference in terms of gender between those who successfully completed the tasks in both arthroscopy models. Conclusion: A basic arthroscopic bench-top simulator may be a low-cost and effective training method to increase arthroscopic skill levels in resident training compared to traditional methods.Öğe Comparison of two techniques in achieving planned correction angles in femoral subtrochanteric derotation osteotomy(Lippincott Williams & Wilkins, 2012) Turker, Mehmet; Cirpar, Meric; Cetik, Ozgur; Senyucel, Cagri; Tekdemir, Ibrahim; Yalcinozan, MehmetIncreased femoral anteversion in cerebral palsy alters biomechanics of gait. Femoral subtrochanteric derotational osteotomies are increasingly performed to improve gait in cerebral palsy. The amount of angular correction can be determined and planned preoperatively but, accuracy in achieving planned angular correction has not been tested experimentally before. The aim of this study was to evaluate the accuracy of the two techniques in achieving planned angular correction. Sixteen dry femora were used in this study. Specimens in both groups were derotated to achieve a desired amount of correction with two different techniques, consecutively. In technique one, the cross section of the femur was assumed to be circular and the desired amount of angular correction was calculated and expressed in terms of surface distance by a geometric formula (surface distance = 2 x pi x radius of femur). In both groups, derotations were made based on this surface distance calculation. Consecutively the same specimens were derotated by pins and guide technique. Femoral anteversion of specimens were measured before and after derotation by computerized tomography. There was a statistically significant differance in planned and achieved correction angles (P = 0.038) in both subgroups derotated by the surface distance technique. When the two techniques were compared, there was significant difference (P = 0.050) between high magnitude correction subgroups (subgroups 2 vs. 4). In conclusion, the results of this study highlighted the difficulty in achieving accurate derotation angles. Derotations based on guide-pins technique yielded more accurate results than derotations based on surface distance technique. In addition, surface diameter technique was not suitable when higher degrees of derotations are needed. In achieving a planned derotation angle two techniques are described for accuracy. Both the techniques have potential pitfalls resulting in malrotations. Surgeons must be aware of these obstacles and try to avoid them. J Pediatr Orthop B 21: 215-219 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.Öğe Distal medial epicondylectomy. A modification of partial medial epicondylectomy for cubital tunnel syndrome: preliminary results(Springer, 2012) Cirpar, Meric; Turker, Mehmet; Ozuak, Cem SeyfiThe medial epicondyle behaves as a fulcrum and a pulley that tethers the ulnar nerve during flexion. Excision of the distal half of the medial epicondyle sets the point of contact of the bone with the nerve proximally and decreases the traction effect of the medial epicondyle on the ulnar nerve. In this study, we aim to investigate the surgical and clinical results of excision of the distal half of the medial epicondyle in cubital tunnel syndrome (CuTS). Cubital tunnel release with excision of the distal half of the medial epicondyle was performed in 19 patients. The patients were evaluated preoperatively and postoperatively with clinical examinations, McGowan and Wilson-Krout scores, Semmes-Weinstein monofilament and two-point discrimination tests, and grip and pinch strength measurements. A one-grade improvement in McGowan classification was observed in 79 % of patients and a two-grade improvement in 21 % of patients at the time of the first postoperative examination. At 24 months after surgery, 18 patients reported the Wilson-Krout scores as excellent (95 %). Statistically significant improvements in sensory and motor strength measurements were achieved at all postoperative examinations. The objective and subjective outcome measures achieved with distal medial epicondylectomy are comparable with other epicondylectomy techniques. The complication rates seem to be lower than those of total or partial medial epicondylectomy. This procedure is an acceptable and safe alternative for the surgical treatment of CuTS.Öğe Dorsal cutaneous innervation of the hand with respect to anatomical landmarks: is there a safe zone?(Turkish Joint Diseases Foundation, 2012) Cirpar, Meric; Esmer, Ali Firat; Turker, Mehmet; Yalcinozan, MehmetObjectives: In this study, we aimed to define the borders of the triangular area between the radial and dorsal nerves on the dorsum of the hand and to determine its dimensions using measurements between anatomic landmarks. Materials and methods: We statistically analyzed the relation between the distance from Lister's tubercle to the blending point of the central branches of radial and ulnar nerves and the distance between styloids on 14 hands of seven adult human cadavers (5 males, 2 females). The distances of nerve branches to vertical lines drown distally from both styloid processes were also compared with interstyloid distances to help in presuming the course of these nerves. Results: No statistical constant correlation was determined between the measurements. Neither the height of the triangular area nor the courses of both nerves seemed to be quantitatively related to any measurements between the anatomical landmarks. Conclusion: Variability in these measurements in our study indicates that there is no surgical safe zone on the dorsum of the hand.Öğe The effectivity of magnetic resonance imaging findings in the diagnosis of bucket handle meniscal tears(Turkish Joint Diseases Foundation, 2012) Turker, Mehmet; Cetik, Ozgur; Cirpar, Meric; Yalcinozan, Mehmet; Comert, Ruhi Baris; Simsek, TalatObjectives: This study aims to test the efficacy of magnetic resonance imaging (MRI) evaluation by a group who were blinded to the arthroscopic diagnosis in patients with known bucket handle meniscal tears. Patients and methods: In this study, MRI scans of 28 patients who were operated due to bucket handle meniscal tear with sufficient documentation were evaluated. Radiographic evaluation was performed by two different groups, including an orthopedist and radiologist. In the first group, evaluation of MRI scans was performed by the specialists who were aware of the arthroscopic diagnosis and marked the defined MRI signs of bucket handle meniscal tear. In the second group, evaluation was done, remaining blinded to the diagnosis, with only initial complaints at admission. The second group also evaluated the MRI scans and marked the pathologic signs. The sensitivity of radiological signs marked by both groups was compared. Invariables were found using blinded evaluation. Results: Double posterior cruciate ligament and free fragment in the intercondylar notch were invariable sensitivities found in the MRI scans by blinded evaluation. The sensitivity of coronal truncation, anterior flip and any free fragment signs were significantly decreased in the setting of blinded evaluation. Conclusion: Preoperative differentiation of reparable bucket-handle tears from irreparable is of utmost importance. As meniscal repair improves knee stability and functional results, surgical repair of meniscal injuries particularly in younger individuals who are scheduled for anterior cruciate ligament reconstruction have a positive effect on clinical outcomes.Öğe The efficacy and safety of limited incision technique in carpal tunnel release(Turkish Joint Diseases Foundation, 2011) Cirpar, Meric; Ari, Mahmut; Turker, Mehmet; Eksioglu, M. Fatih; Cetik, OzgurObjectives: This study aims to determine the safety and symptomatic and functional efficacy of median nerve decompression with 3 cm limited incision in carpal tunnel syndrome surgery. Patients and methods: Carpal tunnel release with a 3 cm limited palmar incision was performed on 91 hands in 83 patients. Patients were evaluated with Boston Carpal Tunnel Questionnaire, grip strength and pinch strength measurements, Semmes-Weinstein Monofilament test and two-point discrimination tests preoperatively, and at postoperative 3(rd) and 6(th) months. The pre- and postoperative mean values for these assessment criteria were statistically analyzed by paired samples t-test. The symptoms, physical findings, electroneuromyography carpal tunnel syndrome severity scores of the patients were evaluated using descriptive statistical analyses. Results: At postoperative evaluation, there was a statistically significant increase in Boston Carpal Tunnel Questionnaire scores, grip and pinch strengths, and sensory tests results of the patients when compared with preoperative values. No complications other than pillar pain were encountered. Conclusion: Carpal tunnel release with a 3 cm limited incision technique appears to be effective when compared with classical open, endoscopic and mini incision techniques. The rate of complications is lower than that of these techniques. In conclusion, a 3 cm limited incision is both effective and safe in carpal tunnel release.Öğe Histological and biomechanical effects of zoledronate on fracture healing in an osteoporotic rat tibia model(Turkish Joint Diseases Foundation, 2016) Turker, Mehmet; Aslan, Arif; Cirpar, Meric; Kochai, Alauddin; Tulmac, Ozlem Banu; Balci, MahiObjectives: This study aims to investigate the effects of zoledronate therapy on histological and biomechanical properties of bone healing via a fracture model generated on osteoporotic rat tibiae. Materials and methods: Ovariectomized 40 Wistar-Dawley female rats weighing 300 g to 350 g were used in the study. After one week, 2 IU/g heparin injection was started subcutaneously. After four weeks of daily injections, osteoporosis was ensued proven with bone mineral density measurements. Osteoporotic rats were separated into four equal groups randomly as group A (control), group B (calcium and vitamin D), group C (0.1 mg/kg subcutaneous zoledronic acid), and group D (calcium and vitamin D / 0.1 mg/kg subcutaneous zoledronic acid). Six weeks later, all rats were sacrificed, their tibiae were resected, and histopathologic and biomechanical studies were performed. Results: Group C (30.2 +/- 1 Nm) and group D (33.3 +/- 3 Nm) had significantly higher peak torque values than group A (21.6 +/- 6 Nm) and group B (23.6 +/- 4 Nm) (p=0.007 and p=0.005, respectively). Group C (1.8) and group D (2.0) had higher stiffness values than group A (1.4) and group B (1.7); however, the difference was not statistically significant (p>0.05 for all). Conclusion: According to histopathological and biomechanical test results, single dose zoledronic acid treatment improves fracture healing in an osteoporotic rat fracture model. Orally administered daily calcium and vitamin D treatment had no effect on fracture healing. There was no additional improvement in fracture healing when calcium and vitamin D treatment was added to zoledronic acid treatment. Positive effects of zoledronic acid treatment on osteoporotic fracture healing and callus quality should be shown by future clinical studies.Öğe Knee Pain and Functional Scores After Intramedullary Nailing of Tibial Shaft Fractures Using a Suprapatellar Approach(Lippincott Williams & Wilkins, 2019) Serbest, Sancar; Tiftikci, Ugur; Coban, Mehmet; Cirpar, Meric; Daglar, BulentObjectives: To evaluate the effects of intramedullar nailing of the tibia using a suprapatellar (SP) approach with respect to pain and function of the knee. Design: Prospective clinical investigation. Setting: Academic level I trauma center. Patients/Participants: Twenty-one patients with tibial shaft fractures (Orthopaedic Trauma Association 42A-B-C) with a minimum of 12-month follow-up. Intervention: Locked intramedullary nailing using a SP approach. Main Outcome Measurements: Radiographic evaluation for nail position proximally, tibial shaft alignment and union, anterior knee pain using the visual analog scale, and knee function evaluation using the Lysholm and SF-36 scores. Examination of intra-articular damage was performed using intraoperative patellofemoral arthroscopy before and after nail insertion. Results: The mean age of the patients was 35.4 +/- 12.4 years (range, 18-63 years), and the mean follow-up period was 15.+/- 2 6 3.2 months (range, 12-21 months). The visual analog scale score for anterior knee pain was a mean of 1.0 +/- 1.3 (range, 0-4). The SF-36 physical score was mean 45.1 +/- 9, and the SF-36 mental score was a mean of 51.7 +/- 9.9. The knee joint range of movement was measured as 133.1 +/- 87 degrees on the affected extremity side and 134.05 +/- 8.4 degrees on the unaffected side. The mean Lysholm knee score was 95.7 +/- 6 4. No intra-articular pathology was seen on arthroscopy after nail insertion. Conclusions: The SP approach for intramedullar nailing for tibial shaft fractures was not associated with either anterior knee pain or functional limitations of the knee in our series.Öğe Mesenchymal stem cells have significant anti-infective effect on methicillin-resistant Staphylococcus epidermidis vascular graft infections(Turkish Joint Diseases Foundation, 2019) Canbeyli, Ibrahim Deniz; Kabalci, Mehmet; Cirpar, Meric; Tiryaki, Meral; Oktas, BirhanObjectives: This study aims to evaluate the effects of mesenchymal stem cell (MSC) implantation on vascular graft infections caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and compare with antibiotic treatment. Materials and methods: Healthy adult 56 Wistar rats (age, over 5 months: weighing. 300-350 g) were divided into eight groups. Group I was defined as the control group and group 2 was defined as the infected control group. Groups 3 and 4 were defined as Dacron grafted and MRSE infected groups. treated with tigecycline and MSCs. respectively. Groups 5 and 6 were performed polytetrafluoroethylene (PTFE) graft and infected with MRSE. These groups were also administered tigecycline and MSC treatment. respectively. Groups 7 and 8 were infected with MRSE without graft administration and were also performed tigecycline and MSC treatment. respectively. Grafts and soft tissue specimens were collected at 13 days postoperatively. Colony counts of pert-graft tissue were performed. All samples were evaluated by enzyme-linked immunosorbent assay (ELISA) for the markers that determine stem cell activity. Results: The overall success of the treatments was assessed by the number of rats with MRSE recurrence, regardless of graft used. The difference between the untreated group 2, tigecycline groups (3. 5 and 7) and MSCs groups (4.6 and 8) were statistically significant. Success of MSC and tigecycline treatments was similar in Dacron. PTFE, and non-grafted groups. There was a resistance of MRSE infection in Dacron groups to MSC and tigecycline treatments. This was considered to be indicative of the susceptibility of the Dacron grafts to infection. However, there was no significant difference between group 2 and Dacron groups in terms of bacterial colonization. ELISA results were significant in three cytokines. Conclusion: Mesenchymal stem cells can be considered as an alternative treatment option on its own or part of a combination therapy for control of vascular graft infections.Öğe Migration of broken K-wires into the achilles tendon from a ostheosynthesed medial malleolar fracture(Springer, 2011) Turker, Mehmet; Cirpar, Meric; Yalcinozan, MehmetKirschner (K-) wires are often used for osteosynthesis of many types of fractures. Dislocation and migration through the tissues, especially when used for shoulder girdle fractures, have been reported previously. K-wire migration after surgery of pelvis and knee was reported before. To the authors' knowledge, broken and migrated K-wires after ankle fractures were not reported before. Here, we report a case with broken and migrated K-wires after open reduction and internal fixation of a medial malleolar fracture.Öğe Postarthroscopy osteonecrosis of the knee(Springer, 2015) Turker, Mehmet; Cetik, Ozgur; Cirpar, Meric; Durusoy, Serhat; Comert, BarisSpontaneous subchondral osteonecrosis of the knee joint confined to a localized area of one condyle can occur after arthroscopic procedures. Meniscal tears, arthroscopic meniscectomy, and radiofrequency chondroplasty are aetiological factors in the development of osteonecrosis. The aim of this study was to investigate whether the incidence of osteonecrosis increased when mechanical or radiofrequency chondroplasty was used in conjunction with arthroscopic meniscectomy. In this prospective clinical trial, arthroscopic meniscectomy was the primary treatment in 75 patients (mean age 40 +/- A 13) with stage II and III degenerative changes on the articular cartilage. Patients had to meet the following criteria: 1) have preoperative MRI and plain film radiographs showing no evidence of osteonecrosis; 2) be symptomatic for at least 6 weeks before the preoperative MRI; and 3) have arthroscopically confirmed stage II or III chondral lesion. A preoperative MRI was performed for all patients. For treatment of chondral lesions, debridement with a shaver or chondroplasty with a monopolar RF energy system was used. Patients were divided into three treatment groups. Partial meniscectomy of the medial or lateral (or both) menisci was performed on all patients, but patients in group 2 additionally received mechanical debridement of the chondral lesion, and those in group 3 were additionally treated with RF chondroplasty. Patients in group 1 were treated with partial meniscectomy alone. Patients were re-examined after 6 months, at which time a repeat MRI was performed. Development of osteonecrosis was detected during the postoperative MRIs of five patients: two in group 1, two in group 2, and one in group 3. The addition of mechanical or RF chondroplasty to meniscectomy did not increase the number of patients with osteonecrosis. Also, RF chondroplasty, which is commonly proposed to be an aetiological factor, resulted in a decrease in the number of patients that developed osteonecrosis. II.Öğe Prospective evaluation of preoperative and postoperative sleep quality in carpal tunnel release(Sage Publications Ltd, 2019) Okkesim, Cuneyt Emre; Serbest, Sancar; Tiftikci, Ugur; Cirpar, MericSleep disturbance is a frequent symptom of carpal tunnel syndrome. The aim of this study was to investigate the effect of median nerve decompression on sleep quality of patients with this condition. The study sample consisted of 41 patients with severe carpal tunnel syndrome who were admitted to our clinic and treated with open median nerve decompression. Sensation and functional recovery of the patients were followed using the Boston Function Questionnaire, the Semmes-Weinstein monofilament test and the two-point discrimination test. Symptomatic recovery of the patients was followed by the Boston Symptom Questionnaire. The tests were used before surgery and at three and six months afterwards. Sensory, functional and symptomatic recovery from the third month to the sixth month following surgery also affected sleep parameters and improved the sleep quality of patients with carpal tunnel syndrome.Öğe Rafting technique without bone grafting in reverse Hill-Sachs lesions(Turkish Joint Diseases Foundation, 2017) Cirpar, Meric; Oktas, Birhan; Daglar, BulentIn this article, we report a case of bilateral posterior shoulder instability, having reverse Hill-Sachs lesions of 25 to 50% of the articular surface on the right side, and of 50% on the left side. The defects were anatomically reconstructed after tuberculum minus osteotomy by elevation of the articular surface and buttressing with raft screws without graft usage. Early rehabilitation with pendulum shoulder exercises was started at third postoperative day. At postoperative sixth week, patient had full range of motion without instability and pain. At postoperative 18th month, the patient had normal physical examination and the constant shoulder score was 86, which was 92.4% of the age-and gender-matched population. Rafting technique without bone grafting may be a treatment alternative with satisfactory clinical results for medium to large sized reverse Hill-Sachs lesions of posterior shoulder instability.Öğe Rotational deformity affects radiographic measurements in distal radius malunion(Springer, 2011) Cirpar, Meric; Gudemez, Eftal; Cetik, Ozgur; Turker, Mehmet; Eksioglu, FatihMalunited distal radius fractures are 3D deformities. The preoperative evaluation of the deformity and surgical planning are usually depended on plain radiographic measurements for corrective osteotomies. In most of the cases, the rotational deformity is disregarded in preoperative planning. We aimed to clarify the effect of rotational deformity on radial inclination and dorsal or volar tilt measurements, which are commonly used as radiologic parameters. This study was performed on standard left radius saw bone models. The malunion models were prepared according to AO distal radius fracture classification system in four main and seventeen subgroups. The differences between the mean radial inclination, volar or dorsal tilt measurements performed on plain radiographies and gold standard values were statistically analyzed. Results showed that rotational deformity causes faulty measurements of radial inclination and dorsal tilt on plain radiographies which may be a contributing factor for unsatisfactory clinical results of corrective osteotomy. We suggest 3D preoperative evaluation of the deformity if possible.
