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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 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 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 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.
