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Biomarkers that Can Predict the Diagnosis of an Anterior Cruciate Ligament Injury on MR Images, Preoperatively
(Galen Sro, 2023) Soy, Furkan; Pehlivan, O.; Oktas, B.; Çırpar, Meriç
PURPOSE OF THE STUDY The competence of the anterior translation of tibia (ATT), posterior cruciate ligament angle (PCLA), and femorotibial rotation angle (FTRA) measured on MR images in predicting anterior cruciate ligament (ACL) injury was evaluated in this study. MATERIAL AND METHODS 266 patients who underwent diagnostic arthroscopy between 2015-2020 were included in this study. Age, gender, radiological findings included ATT, PCLA, and FTRA were measured on preoperative MR images of all patients. RESULTS ACL tear was detected in 143 of patients and most of them were younger males. In ACL-R group, the ATT was 7 mm (-4-17 mm), PCLA value was 110 degrees (52 degrees-157 degrees), and FTRA value was 5.8 degrees (-5 degrees-18 degrees), while in ACL-I group, the ATT was approximately 5 mm (-4-12 mm), PCLA value was 122 degrees (82 degrees-162 degrees) and FTRA value was 1.6 degrees (-10.9 degrees-10 degrees) (p<0.001). ROC-Curve test results showed that if ATT value was >6.05 mm (63% sensitivity, 65% specificity) if PCLA value was <116.5 degrees (65% sensitivity, 70% specificity) and if FTRA value was >3.45 degrees (73% sensitivity, 72% specificity), these parameters could predict the probability of ACL tear, preoperatively. The Logistic Regression test results revealed that the PCLA and FTRA values could be the best markers to predict the probability of ACL tear, preoperatively. CONCLUSIONS This study results showed that the ATT, PCLA, and FTRA values could be used as predictive markers in diagnosis of ACL tear, preoperatively. Among these three values, it was concluded that the FTRA could have the highest sensitivity and specificity ratios and the best predictive value.
The effectiveness of fixation of hydroxyapatite-coated helical blade in preventing of the cut-out observed in treatment with proximal femoral nail of fractures of the femur intertrochanteric in elderly
(Turkish Assoc Trauma Emergency Surgery, 2023) Tosun, Haci Bayram; Uludag, Abuzer; Serbest, Sancar; Cicek, Necati; Demir, Sukru
BACKGROUND: This study aimed to retrospectively evaluate the effectiveness of hydroxyapatite-coated (HA-coated) implants and other caput-collum implants in preventing cut-out observed in treatment with proximal femoral nail (PFN) of intertrochanteric femur fractures in elderly patients.METHODS: A total of 98 consecutive patients (56 males and 42 females; mean age: 79.42 (61-115) years) treated with three differ-ent PFNs for intertrochanteric femoral fractures were retrospectively examined. The mean of the follow-up period was 7.87 (4-48) months. It was used a threaded lag screw in 40 patients, an HA-coated helical blade in 28 patients and a non-coated helical blade in 30 patients for PFN. The reduction quality, fracture type, and radiological outcomes among all groups were evaluated.RESULTS: Unstable type was seen in 50 (52.1%) patients according to AO Foundation/Orthopedic Trauma Association fracture classi-fication. An acceptable-good reduction quality was seen in 87 (88.8%) of all patients. The average of tip-apex distance (TAD) value was 27.61 mm, calcar-referenced TAD (CalTAD) value was 28.72 mm, caput-collum diaphyseal angle was 128,degrees Parker's anteroposterior ratio was 46.36%, and Parker's lateral ratio was 46.82%. The best suitable implant position was observed in 49 (50%) patients. Cut-out was observed in 7 (7.14%) patients, and secondary varus displacement of more than 10 degrees was observed in 12 (12.24%) patients. Correlation analysis and multivariate logistic regression analysis showed a significant difference between HA-coated and other implants in cut-out. Furthermore, implant type was the strongest predictive factor for cut-out complications in the multivariate logistic regression analysis.CONCLUSION: HA-coated implants may reduce the long-term cut-out risk due to increased osteointegration and bone ingrowth in elderly patients with intertrochanteric femoral fractures with poor bone quality. However, this alone is not enough; a suitable screw position, optimal TAD values, and excellent reduction quality are other important factors.
Effects of a novel biodegredable implant system on a rat tibia fracture model
(2020) Yalçınozan, Mehmet; Türker, Mehmet; Çırpar, Meriç
Objective: This study aimed to determine the effects of a novel biodegradable implant releasing platelet-derived growth factor (PDGF) at the fracture site on fracture healing in a rat tibia fracture model. Methods: In this study, 35 male Sprague-Dawley rats weighing between 300 and 350g were used. The rats were divided into four groups: Group A (control group without any treatment, n=10), Group B (spacer without PDGF Group, n=10), Group C (spacer with PDGF group, n=10), and Group D (healthy rat Group, n=5). Standardized fractures were created in the right tibias of rats, and then biodegradable implants made of poly-?-hydroxybutyrate-co-3-hydroxy valerate were implanted at the fracture sites in Groups B and C. In Group C, implants were loaded with 600 ng of PDGF. Animals were sacrificed 30 days after the operation, and fracture healing in each group was assessed radiologically based on the Goldberg score. Furthermore, the anteroposterior (AP) and mediolateral (ML) callus diameters were measured macroscopically, and fracture sites were mechanically tested. Results: In the radiological assessment, Group C showed higher fracture healing rate than Groups A and B (p=0.001), whereas no significant difference was found between group C and Group D (p>0.05). In the macroscopic assessment, while Group C exhibited the thickest AP callus diameter (p=0.02), no significant differences in ML callus diameters existed among the groups (p>0.05). Mechanical testing revealed that Group C had higher torsional strength (p=0.001) and stiffness than Groups A and B (p=0.001) while there was no significant difference between Groups C and D (p>0.05).
Tavşanlarda Horizontal Menisküs Yırtık Modellerinde Primer ve Kollajen Skafold ile İyileşme
(2019) Kılınç, Cem Yalın; Tiftikçi, Uğur; Serbest, Sancar; Türk, Mustafa; Karahan, Siyami
Bu çalışmanın amacı, tavşan modelinde horizontal menisküs yırtıklarının onarımında kollajen skafold kullanımı sonrası menisküsün iyileşme potansiyelini araştırmak ve skafold ile tamirin primer tamirden daha üstün olup olmadığını göstermektir. Ağırlıkları 2.5-3 kg arasında değişen olgun 21 adet New Zealand White cinsi erkek tavşanlar her grupta 7 hayvan olacak şekilde 3 eşit gruba ayrıldı. Medial menisküs anterior boynuzdan orta kısmına kadar horizontal yırtık modeli yapıldı. Çalışma protokolüne uygun olarak, Grup 1 (n=7); kontrol grubu sadece horizontal menisküs yırtığı olan tavşanlardan oluşturuldu. Grup 2 (n=7); horizontal menisküs yırtığa primer tamir yapılırken, Grup 3; horizontal menisküs yırtığa kollajen skafold ile tamir yapılanlar idi. Tüm deney hayvanları 12. haftanın sonunda sakrifiye edildi. Medial menisküsün 1/3 anterior alanı ölçüldü. Dokuların histolojik analizi, üç bileşenden oluşan Ishida skoru ile gerçekleştirildi. Grup I'deki menisküsün yüzey alanı grup II’den (p<0.008) ve grup III'ten (p<0.002) anlamlı olarak daha düşüktü. Grup III’deki dokunun kalitesi İshida puanına göre değerlendirildiğinde diğer gruplardan anlamlı olarak daha yüksekti (p<0.001). Horizontal menisküs yırtıkları gibi avasküler bölgelerindeki yırtıklarda skafold ve benzeri materyaller ile daha iyi iyileşme ve normal anatomik dokuya yakın işlev ve fonksiyonda menisküs elde edilebilir.
Ters Hill-Sachs lezyonlarında kemik greftlemesi olmaksızın rafting tekniği
(2017) Çırpar, Meriç; Oktaş, Birhan; Dağlar, Bülent
Bu çalışmada, sağ tarafta eklem yüzeyinin %25-50'si ve sol tarafta %50'si kadar ters Hill-Sachs lezyonu olan çift taraflı bir posterior omuz instabilitesi olgusu bildirildi. Defektler tüberkulum minus osteotomisi sonrası eklem yüzeyinin yükseltilmesi ve greft kullanılmadan raft vidaları ile desteklenmesi yoluyla anatomik olarak yeniden yapılandırıldı. Ameliyat sonrası üçüncü günde pandüler omuz egzersizleri ile erken rehabilitasyona başlandı. Ameliyat sonrası altıncı haftada hastanın hareket açıklığı instabilite ve ağrı olmaksızın tam idi. Ameliyat sonrası 18. ayda hastanın fizik muayenesi normal ve constant omuz skoru yaş ve cinsiyet dengi popülasyonun %92.4'ü olacak şekilde 86 idi. Kemik greftlemesi olmaksızın rafting tekniği, posterior omuz instabilitesinde orta ila büyük boyutlu ters Hill-Sachs lezyonlarında tatmin edici klinik sonuçları ile bir tedavi alternatifi oluşturabilir
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.
Kova sapı menisküs yırtığı tanısında manyetik rezonans görüntüleme bulgularının etkinliği
(2012) Türker, Mehmet; Çetik, Özgür; Çırpar, Meriç; Yalçınozan, Mehmet; Cömert, Ruhi Barış; Şimşek, Talat
Amaç: Bu çalışmada, diz ekleminde kova sapı menisküs yırtığı olduğu bilinen hastalarda ameliyat öncesi manyetik rezonans görüntülemenin (MRG), artroskopik tanıyı bilmeyen bir grup tarafından değerlendirilmesinin etkinliğini ölçüldü. Hastalar ve yöntemler: Bu çalışmada diz ekleminde kova sapı menisküs yırtığı nedeniyle cerrahi olarak tedavi edilmiş ve kayıtları yeterli olan 28 hastanın MRG görüntüleri kullanıldı. Radyografık değerlendirme, ortopedi ve radyoloji uzmanından oluşan iki grup tarafından yapıldı. Birinci grup, artroskopik tanıyı bilerek, MRG taramalarını inceledi ve tanımlanmış olan kova sapı menisküs yırtığı MRG bulgularını işaretledi. İkinci gruba ise, değerlendirme öncesinde hastanın yalnızca başvuru yakınmaları bildirildi. İkinci grup da MRG taramalarını inceledi ve patolojik bulguları işaretledi. Her iki grupta saplanan radyolojik bulguların hassasiyeti karşılaştırıldı. Kör değerlendirme ile değişmezler belirlendi. Bulgular: Kör değerlendirme ile MRG taramalarında bulunan. hassasiyeti değişmeyen bulgular çift arka çapraz bağ ve interkoııdiler çentik içinde serbest fragman idi. Koronal trunkasyon, anteriyor kayma ve herhangi bir serbest fragman bulgularının fark edilme oranı, artroskopik tanı bilinmediğinde, ciddi oranda azaldı. Sonuç: Kova sapı yırtıkların cerrahi tamir gerektirmeyen diğer yırtıklardan ameliyat öncesi ayırt edilmesi önemlidir. Özellikle genç ve ön çapraz bağ rekonstrüksiyonu yapılacak hastalarda menisküs tamiri yapılması, diz stabilitesinin ve fonksiyonel sonuçlarının daha iyi olması nedeniyle, klinik sonuçlar üzerinde olumlu bir etkiye sahiptir.
Karpal tünelin gevşetilmesinde sınırlı insizyon tekniğinin etkinliği ve güvenilirliği
(2011) Çırpar, Meriç; Arı, Mahmut; Türker, Mehmet; Ekşioğlu, M. Fatih; Çetik, Özgür
Amaç: Bu çalışmada, karpal tünel sendromu cerrahisinde 3 cm’lik sınırlı insizyon ile gerçekleştirilen medyan sinir dekompresyonunda güvenilirliğin, fonksiyonel ve semptomatik etkinliğin belirlenmesi amaçlandı. Hastalar ve yöntemler: Seksen üç hastanın 91 elinde 3 cm’lik sınırlı palmar insizyon ile karpal tünel gevşetmesi yapıldı. Hastalar cerrahi öncesinde ve sonrasında 3. ve 6. aylarda, Boston Karpal Tünel Anketi, kaba ve ince kavrama gücü ölçümleri, Semmes Weinstein Monofilaman testi ve iki nokta ayrım testi ile değerlendirildi. Bu değerlendirme kriterlerinin ameliyat öncesi ve sonrası ortalama değerleri eşleştirilmiş iki grup t-testi ile istatistiksel olarak analiz edildi. Hastaların semptomları, fiziksel bulguları ve elektronöromiyografik karpal tünel sendromu ciddiyet skorları ise tanımlayıcı istatistiksel analizler ile değerlendirildi. Bulgular: Ameliyat sonrası değerlendirmede hastaların Boston Karpal Tünel Anketi skorlarında, kaba ve ince kavrama güçlerinde ve duyu testlerinde ameliyat öncesi değerler ile karşılaştırıldığında istatistiksel olarak belirgin artış vardı. Pillar ağrısı dışında komplikasyon saptanmadı. Sonuç: Üç santimetrelik sınırlı insizyon tekniği ile karpal tünel gevşetmesi klasik açık, endoskopik ve mini insizyon teknikleri ile karşılaştırıldığında etkili gibi görünmektedir. Komplikasyon oranları bu teknikler ile kıyaslandığında daha düşüktür. Sonuç olarak, 3 cm’lik sınırlı insizyon, karpal tünel gevşetmesinde hem etkili hem de güvenlidir.
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.
Congenital extensor tendon dislocation causing pseudotriggering of the little finger
(2017) Çırpar, Meriç; Dağlar, Bülent; Oktaş, Birhan
The main complaints in extensor tendon dislocations are pain, swelling, sense of discomfort, snapping and difficulty in writing and forceful flexion. However, congenital extensor tendon subluxations may present with triggering of the fingers due to tendon dislocations. Unnecessary A1 pulley release may be performed for pseudotriggerring with unsuccessful results. Here, we report an unusual case of congenital extensor tendon subluxation of multiple digits with triggering of the left little finger and aim to attract notice to pseudotriggering of the digits due to tendon dislocations. An extensor hood reconstruction performed by an extensor digitorum communis tendon slip which is passed beneath the deep intermetacarpal ligament is a successful choice of treatment for these patients.
Comparison of various tendon repair techniques in extansor zone 3 injuries: an experimental biomechanical cadaver study
(SPRINGER, 2020) Uludag, Abuzer; Tosun, Haci Bayram; Celik, Suat; Serbest, Sancar; Kayalar, Murat; Aytac, Gunes; Sindel, Muzaffer
Purpose To compare five different repair techniques for extensor tendon zone III modified Kessler (MK), double-modified Kessler (DMK), modified Kessler epitendinous (MKE), double-modified Kessler epitendinous (DMKE), and running-interlocking horizontal mattress (RIHM) in terms of shortening, stiffness, gap formation, and ultimate load to failure. Methods A total of 35 human cadaver fingers were randomly assigned to five suture techniques with 7 fingers each and were tested under dynamic and static loading conditions. Results DMK was found to be superior over MK in terms of ultimate load to failure (36 N vs. 24 N, respectively), shortening (1.75 vs. 2.20 mm, respectively) and gap formation. However, these two methods had similar characteristics in terms of stiffness. The addition of epitendinous sutures to the repair methods resulted in approximately 40% increase in ultimate load to failure, whereas epitendinous sutures had no effect on shortening. DMKE was found to be superior over MKE in terms of shortening (1.77 vs. 2.22 mm, respectively). However, these two methods had similar characteristics in terms of mean ultimate load to failure and stiffness. RIHM was found to be superior over the other four methods in terms of ultimate load to failure (89 N), stiffness, and shortening (0.75 mm). Conclusion RIHM was found to be stronger and more durable for extensor tendon zone III than the other techniques in terms of ultimate load to failure and stiffness.
The Effect of Kinesio Taping Versus Splint Techniques on Pain and Functional Scores in Children with Hand PIP Joint Sprain
(TAYLOR & FRANCIS INC, 2020) Serbest, Sancar; Tiftikci, Ugur; Durgut, Erdogan; Vergili, Ozge; Kilinc, Cem Yalin
Introduction: Due to the continual increase in the number of children engaging in sports today, physicians encounter finger injuries at an increasing frequency. This study sought to investigate the effectiveness of the method of Kinesio taping versus classic finger splint technique on pediatric patients with PIP (proximal interphalangeal) joint sprains of the fingers. Method: This is a retrospective cohort study. Forty-nine pediatric patients with PIP joint sprains were included in the study. The patients were divided into two groups, Group 1 being those treated with Kinesio taping and Group 2, those treated with splints. The area around the PIP joint was measured before and after treatment. Visual analog scale (VAS) evaluation: nighttime pain, numbness, pain at rest, and pain during activity were each separately evaluated before and after treatment. Also, flexion was measured at rest and in active motion before and after treatment. Results: The patients' periarticular measurements of the affected joint were statistically significant in both groups after treatment (p < 0.001). In the comparison between the groups, it was found that the group treated with Kinesio taping displayed a better outcome (p < 0.021). According to the VAS for PIP joint pain, it was observed that in both groups, pain at rest, pain during activity, nighttime pain, and numbness were statistically significant after treatment (p < 0.001). In the comparison of the groups, it was seen that the difference was statistically significant only in terms of nighttime pain (p < 0.013). Conclusions: The study conducted supported the literature that Kinesio taping method does not restrict the function of the extremity to which it is applied and also does not produce the complications reported in other treatment techniques. Kinesio taping was found to have a higher patient compliance and the outcomes were better in terms of edema and joint range of motion as well as night time pain when compared to the group treated with splint.
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.
Crescent Technique with Dual C-Shaped Reconstruction Plates for Posterior Acetabular Wall Fractures
(TAYLOR & FRANCIS INC, 2019) Kilinc, Cem Yalin; Acan, Ahmet Emrah; Gultac, Emre; Kilinc, Rabia Mihriban; Serbest, Sancar; Tiftikci, Ugur; Aydogan, Nevres Hurriyet
Background:Here we have defined a novel technique for repairing posterior acetabular wall fractures called the "crescent technique," in which dual C-shaped reconstruction plates overlap at the distal ends and, if necessary, at the proximal ends. We also analyzed the efficacy and reliability of this method.Patients and Methods:This was a retrospective analysis of 27 patients undergoing the crescent technique. All of the fractures were treated by the senior author for a mean of 7.9 days (0-15 days) after the trauma. The mean follow-up period was 19 months (13-29 months). The clinical results were evaluated using the modified clinical grading system developed by Merle d'Aubigne and Postel, and then modified by Matta. The radiographs were graded according to the criteria described by Matta.Results:In the clinical grading, 16 (59%) of the patients were excellent and very good, 5 (19%) were good, 3 (11%) were moderate, and 3 (11%) were poor. According to the Matta radiological evaluation criteria, 19 (70%) were excellent, 4 (15%) were good, 4 (15%) were fair, and none were poor. Statistically significant consistency was seen between the clinical and radiological results (p = 0.002).Conclusions:The crescent technique is a dual plate technique modification that can provide a stable fixation. It appears to be an effective and reliable method for treating posterior wall fractures of the acetabulum.
Effectiveness of Iloprost in the Treatment of Bone Marrow Edema
(CUREUS INC, 2020) Tosun, Haci Bayram; Uludag, Abuzer; Demir, Sukru; Serbest, Sancar; Yasar, Mehmet Mete; Oznam, Kadir
Background and objective Bone marrow edema (BME) is a rare condition caused by insufficient osseous blood supply and may result in severe pain that has adverse effects on patients' life. To date, various conservative treatments have been recommended for the treatment of BME, including analgesics, immobilization of the affected extremity, and iloprost infusion. The aim of this retrospective study was to investigate the effectiveness of parenteral iloprost therapy in the treatment of BME detected in different skeletal locations. Materials and methods This retrospective study included 23 patients (17 men and six women) with BME who were classified as stage I-III according to the Association Research Circulation Osseous (ARCO) classification. BME was localized to the proximal femur in 13 (56.5%), the distal femur in four (17.4%), tarsal bone in four (17.4%), and tibial plateau in two (8.7%) patients. The mean age of the patients was 46.7 years and all the patients were evaluated with the Visual Analog scale (VAS), Functional Mobility Scale (FMS), and MRI. Results A significant improvement was observed in the post-treatment VAS and FMS scores of all patients compared to their pre-treatment scores. Moreover, the edema regressed completely in 60.9% of the patients at three months of MRI control. No serious side effects were observed during the treatment in any of the patients. However, transient side effects including headache, arrhythmia, and flushing were observed in five patients. Conclusion The present study indicated that iloprost therapy is an effective and safe option in the treatment of BME patients, particularly in the reduction of severe pain that has adverse effects on patients' social life, regardless of ARCO staging. Moreover, this therapy could be particularly useful in reducing pain, improving functional recovery, and achieving complete regression of the edema on MRI in ARCO stage I-II patients.
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, Bulent
Objectives: 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.
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, Birhan
Objectives: 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.
Evaluation of arthroscopic rotator cuff repair results in patients with anterior greater tubercle cysts
(Sage Publications Ltd, 2019) Sahan, Mehmet Hamdi; Serbest, Sancar; Tiftikci, Ugur; Durgut, Erdogan; Inal, Mikail
Purpose: The purpose of this study was to investigate the clinical results of arthroscopic rotator cuff repair in patients with anterior greater tubercle cyst in magnetic resonance imaging (MRI). Methods: The cyst-present group comprised 38 patients with anterior greater tubercle cyst in MRI, and age- and sex-matched 30 patients without cyst in humeral head were included in the control group. The cystic group was divided into two groups, smaller than 5 mm (21 patients) and larger than 5 mm (17 patients), according to the cyst size. A total of three groups were created. In the evaluation of clinical outcomes, modified University of California at Los Angeles (UCLA) and the Western Ontario Rotator Cuff Index (WORC) were used. The visual analog scale (VAS) was used to assess pain. One-way analysis of variance was used to compare VAS, UCLA, and WORC scores among the groups. Results: There was a statistically significant difference in the clinical results of VAS, UCLA, and WORC among the cystic and noncystic groups in the anterior greater tubercle (p < 0.05). There was also a statistically significant difference in the clinical results of UCLA, WORC, and VAS scores according to the cyst sizes in the anterior greater tubercle cyst group (p < 0.05). Conclusion: Anterior greater tubercle cysts have negative effects on rotator cuff repair results. If the anterior greater tubercle cyst size is greater than 5 mm, the negative effects of rotator cuff repair results are more pronounced. An understanding of anterior greater tubercle cysts has a critical importance for rotator cuff surgery planning.
Prospective evaluation of preoperative and postoperative sleep quality in carpal tunnel release
(Sage Publications Ltd, 2019) Okkesim, Cuneyt Emre; Serbest, Sancar; Tiftikci, Ugur; Cirpar, Meric
Sleep 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.
Osborn wave in hypothermia and relation to mortality
(W B Saunders Co-Elsevier Inc, 2019) Eroğlu, Oğuz; Serbest, Sancar; Küfeciler, Tarkan; Kalkan, Asım
Background & aim: The aim of this study was to compare hypothermia patients with and without an Osborn wave (OW) in terms of physical examination findings, laboratory results, and clinical survival. Methods: The study was carried out retrospectively on hypothermic patients. The hypothermic patients were divided into two groups. Group 1 comprised patients with OW on electrocardiogram (ECG), and Group 2 comprised patients without OW on ECG. The Mann-Whitney U test was used to compare the two groups, and the relationships between the variables and the presence of OW and mortality were analyzed with ANOVA. A value of p < 0.05 was considered statistically significant. Results: OW was detected on ECG of 41.9% of the patients (Group 1). The mean body temperature was 30.8 +/- 4.1 degrees C in Group 1 and 33.3 +/- 1.6 degrees C in Group 2 (p = 0.106). The mean creatinine level was 1.01 +/- 0.6 mg/dl in Group 1 and 0.73 +/- 0.5 mg/dl in Group 2 (p = 0.046). The mean bicarbonate level was 15.9 +/- 3.8 mmol/l in Group 1 and 18.6 +/- 3.5 mmol/l in Group 2 (p = 0.038). A relationship was determined between the presence of OW and pH, bicarbonate, and creatinine levels (p = 0.026; 0.013; 0.042, respectively). The mortality rate was 69.2% in Group 1 and 77.8% in Group 2 (p = 0.689). Conclusion: Although there is a relationship between the decrease in bicarbonate levels, changes in kidney functions that cause acidosis, and the presence of OW, it has no effect on mortality. The presence of OW in hypothermic patients is insufficient to make a decision regarding mortality. (C) 2018 Elsevier Inc. All rights reserved.

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