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    Children with fractures show higher levels of impulsive-hyperactive behavior
    (Lippincott Williams & Wilkins, 2007) Uslu, Murad; Uslu, Runa; Eksioglu, Fatih; Özen, Nurper Erberk
    Children with fractures have been reported to have impulsive-hyperactive behavior problems although whether they exhibited such behavior more often than children with other orthopaedic conditions is unknown. We investigated whether impulsivity-hyperactivity was more prominent in children with extremity fractures than in children with orthopaedic conditions not involving a fracture. From outpatient clinical intakes, we recruited 39 consecutive children with extremity fractures and 33 children with orthopaedic conditions not involving a fracture. We used the Conners' Parent Rating Scale to detect behavioral symptoms in children with and without extremity fractures. Children who were treated for extremity fractures had higher mean scores for impulsivity-hyperactivity than those treated for nontrauma-related reasons. Additionally, more children in the fracture group reached impulsive-hyperactive behavior scores high enough to warrant additional psychiatric evaluation. In terms of injury prevention, the orthopaedic surgeon should be familiar with problem behaviors of children, particularly impulsivity and hyperactivity, to be able to make appropriate referrals for psychiatric evaluation and treatment.
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    Computerized tomography scout view for determining distal femoral resection angle in intramedullary instrumentation of total knee arthroplasty
    (Springer, 2007) Uslu, M. Murad; Özsar, Barış; Çirpar, Meriç; Kara, Simay; Eksioglu, Fatih; Çetik, Özgür
    This study aims to investigate the results of distal femoral resection by determining the difference between mechanical and anatomical axes of femur using computerized tomography (CT) scout views in pre-operative planning of total knee arthroplasty. CT scout view of the lower extremities was taken before and after the operation in 16 patients undergoing total knee arthroplasty. Distal femoral resection was performed according to the previously determined ideal resection angle (IRA) using intramedullary instrumentation. At post-operative scanogram, femoral component deviation (FCD) was measured. The results were statistically analyzed. The average IRA was 6.95 (5-9) degrees. At post-operative measurements, the average FCD was 0.63 (0-3) degrees. CT scout films improve the accuracy in distal femoral resection and femoral component alignment.
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    Etiology of senile osteoporosis - A hypothesis
    (Springer, 2006) Atık, O. Sahap; Uslu, M. Murad; Eksioglu, Fatih; Satana, Tolgay
    Osteoporosis is a major health problem characterized by compromised bone strength predisposing patients to an increased risk of fracture. It may cause morbidity and mortality in elderly men and women. The etiologic factors that lead to senile osteoporosis still are unclear. Based on the available experimental and clinical evidence, we update our earlier proposal that zinc deficiency plays a role in the pathogenesis of senile osteoporosis. However, the mechanism of zinc deficiency in osteoporosis remains unclear. Zinc deficiency may lead to the increase of endogenous heparin probably causing degranulation of mast cells and release of endogenous heparin, and an increase in the bone-resorbing effect of prostaglandin E2. Endogenous heparin and prostaglandin E2 are probably cofactors of parathyroid hormone and may have a role in the pathogenesis of senile osteoporosis enhancing the action of parathyroid hormone. Therefore, zinc replacement by dietary zinc supplementation might be valuable to prevent or treat senile osteoporosis. Additional studies are necessary for the evaluation of the possible role of zinc in the etiology of senile osteoporosis.
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    Histological alterations after irradiation of cartilage using Ho: YAG laser
    (Mary Ann Liebert Inc Publ, 2003) Atik, OS; Erdoğan, Deniz; Ömeroğlu, Suna; Korkusuz, Feza; Uslu, Murad M.; Eksioglu, Fatih
    The authors carried out an experimental study to evaluate the histological alterations after irradiation of cartilage using Holmium:YAG (Ho:YAG) laser VersaPulse Select 60 watts and Infra. Tome Delivery Systems 30degrees Handpiece (spot size at fiber tip 0.4 mm; Coherent Medical, Palo Alto, CA). Background Data: Recently, some authors reported cases with articular cartilage damage following arthroscopic laser surgery in the knee joint for the treatment of articular cartilage or meniscal pathology. Materials and Methods: The cartilage specimens immersed in saline were exposed to Ho:YAG laser irradiation. The laser wavelength was 2.1 mum, and pulse duration was 250 musec. Power settings were 0.2-1 joules per pulse and 10-15 Hz. Total laser energy used in these procedures was 1.5 K joules. During the procedures, the handpiece was used at an angle of 30degrees and at a distance of 1 mm. Results: Electron microscopic evaluation demonstrated that the ultrastructure of the cartilage is preserved in both experiment and control groups. Conclusion: When Ho:YAG laser is used in optimal dosage (optimal joule and Hertz) with optimal technique (keeping the handpiece at an appropriate angle and distance) and avoiding overtreatment, it does not cause cartilage damage.
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    Immunohistological Analysis of Normal and Osteoarthritic Human Synovial Tissue
    (J Michael Ryan Publishing Inc, 2005) Korkusuz, Petek; Dagdeviren, Attila; Eksioglu, Fatih; Ors, Ulken
    Intercellular communication mediated by cell surface antigens is important in the maintenance of synovial tissue (ST) integrity. Chronic inflammation is a common feature of osteoarthritis (OA). Cellular attachment to and migration into ST is one of the critical aspects of chronic inflammation. This study was undertaken to examine the tissue distribution of a broad spectrum of monoclonal antibodies (mAbs) containing tetraspan antigens (CD9, CD63, CD151), endothelial cell antigens (CD31, CD36, CD105, CD106, CD146), integrins (CD49a- f, CD29, CD41, CD51, CD61), CD39, CD98, CD99, CD143 and, CD147 supplied from fifth and sixth international workshops and conferences on human leukocyte differentiation antigens in a comparative manner in human OA and normal synovium. Ten primary OA patients and six normal individuals were included in this study. The average age of the patients was 65.0 +/- 8.3 years and the average age of the controls was 31.8 +/- 5.3 years. Sections were screened using an indirect immunoperoxidase method. Tetraspan antigens and CD98 presented rather unique staining pattern in OA synovium suggesting special roles for each antigen on the synovial lining layer (SLL). Endothelial cells and type A synoviocytes expressed CD31 and CD36 in OA, but only endothelium in normal subjects. Integrins presented a uniform staining pattern in both groups. There was a positive reaction in some of the ST stromal elements for CD143 in all specimens. In conclusion, human normal and OA synovium were comparatively reviewed by a broad spectrum of mAbs with special attention being given to their functional aspects. This data suggests a significant difference in antigenic phenotype of SLL cells in OA and ST not to be considered at a normal- like state in OA. The fact that their activation was independent of the degree of lymphocyte infiltration further emphasizes the possible central importance of SLL.
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    Localized pigmented villonodular synovitis of the knee: acute onset in pregnancy
    (Springer, 2006) Uslu, Murad; Çetik, Özgür; Atasoy, Pınar; Eksioglu, Fatih; Engin, Murat
    A pregnant patient in the first trimester presented with acute onset knee pain and effusion. As the clinical status was mimicking septic arthritis, surgery was performed. Arthroscopy demonstrated a local synovial tumor and excision was performed with arthrotomy. Microscopic evaluation revealed localized pigmented villonodular synovitis. Due to the presence of necrosis and hematoma in the tumor, we hypothesize that, that torsion or bleeding of the tumor in the presence of physiological pregnancy- related metabolic changes might have been the cause of acute presentation.
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    Osteochondral Multiple Autograft Transfer (OMAT) for the Treatment of Cartilage Defects in the Knee Joint
    (J Michael Ryan Publishing Inc, 2005) Atik, O. Sahap; Uslu, M. Murad; Eksioglu, Fatih
    The ideal articular cartilage repair tissue should be durable and well-integrated. We have been performing osteochondral multiple autograft transfers (OMAT) since 1996 with the experience we had using carbon fiber implants. We call this technique OMAT instead of mosaicplasty because we use uniform osteochondral autografts. Osteochondral multiple autograft transfer (OMAT) was performed either by arthrotomy or arthroscopy on 12 patients (6 male and 6 female) for the treatment of cartilage defects in the knee joint. The patients ranged in age from 20 to 63 years (mean: 38 years). All had weightbearing- related pain or decrease in the range of motion. None had instability or malalignment. The average follow-up time was 4 years (range: 2 to 8 years). Clinical results were satisfactory. All of the paients were improved initially by the procedure and 85% are still pain free. The mean Lysholm knee rating score was 56 points preoperatively and 86 points postoperatively. Second-look arthroscopy (five patients) demonstrated a normal shiny appearance and color of the grafted area. We observed slight joint effusion postoperatively that disappeared in two months. There was no donor site morbidity. OMAT is a promising surgical technique for the treatment of articular cartilage defects. Long-term follow-up with more patients and histological and biomechanical evaluation of chondral interfaces are the subjects of our continuing study.
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    Rotational deformity affects radiographic measurements in distal radius malunion
    (Springer, 2011) Cirpar, Meric; Gudemez, Eftal; Cetik, Ozgur; Turker, Mehmet; Eksioglu, Fatih
    Malunited 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.