Browsing by Author "Aktuglu, K"

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    Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: A prospective randomised clinical study
    Özkayin, N; Okçu, G; Aktuglu, K
    Introduction: The purpose of this prospective randomised study is to compare in the elderly the functional results of intertrochanteric femur fractures treated either with closed reduction and internal fixation with proximal femoral nailing or cemented hemiarthroplasty. Materials and methods: The study included patients above the age of 75 who were diagnosed with intertrochanteric femur fracture and admitted to the Department of Orthopaedics and Traumatology, Ege University Hospital between October 2006 and December 2012. After informed consent was obtained from the patients, they were randomised via sealed opaque envelops into two groups. Patients in Group 1 were internally fixated utilizing proximal femoral nail, whilst the patients in Group 2 were treated with a cemented hemiarthroplasty. Complications were recorded and functional results were evaluated using the Harris Hip score. The mean time of follow up was 31.72 months (min. 18-max. 47, std. dev. +/- 10.68). Results: A total of 54 patients were included in the study. 21 of them (38.9%) received a proximal femoral nail whilst 33 (61.1%) were treated with hemiarthroplasty. Average age of the patients was 82.24 (min. 75-max. 97). Average age in Group 1 was 79.57 (min. 75-max. 91), whilst it was 83.94 in Group 2 (min. 75-max. 97). Harris Hip score analysis revealed that the difference between the patients treated with hemiarthroplasty and proximal femoral nailing was statistically significant in favour of the hemiarthroplasty group within the first 3 months. However, this difference diminished at the 6th month time point, and even reversed as of the 12th month postoperatively. Discussion and conclusions: Although cases with hemiarthroplasty achieved a better level of activity in the beginning, cases with proximal femoral nailing reached a comparable level of activity within a short period of time, faster than those treated with hemiarthroplasty, displaying a better level of activity in the end. (C) 2015 Elsevier Ltd. All rights reserved.
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    Surgical treatment of displaced radial neck fractures in children with metaizeau technique: Late-term results Metaizeau technique : Late term results
    Tosyali, HK; Hancioglu, S; Kaya, H; Okçu, G; Aktuglu, K
    Aim: in this study, we aimed to analyze the functional and radiological outcomes of displaced radial neck fractures in children treated with the Metaizeau technique . Material and Methods: This was a retrospective study, and data were collected prospectively. Thirty-eight patients with grade III and grade IV radial neck fractures according to the classification of Judet et al were managed surgically by Metaizeau technique. All patients were surgically treated with percutaneous k-wire leverage reduction and retrograde transphyseal k-wire fixation. The functional results were evaluated using the Metaizeau functional scoring system. Clinical evaluation and results were performed using the Mayo elbow performance score (MEPS), ROM of the elbow (flexion, extension) and forearm (supination, pronation) was measured with a goniometer. Complications were also evaluated. Results: The average follow-up time was 64.9 months (28 -120 months), there were no patients with nonunion, avascular necrosis, infection, posterior interosseous nerve (PIN) injury, heterotopic ossification or radioulnar synostosis. There were 31 (88.5 %) excellent or good results and 4 (11.5 %) fair results according to the Metaizeau classification. The final X-rays showed fracture healing in all patients. No patient developed complications. Discussion: Intramedullary pinning, as described by Metaizeau, is a reliable and reproducible surgical method to treat radial neck fractures in children, which provides excellent or good results and has a low risk of complications.
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    Antegrade nailing of femoral shaft fractures combined with neck or distal femur fractures - A retrospective review of 25 cases, with a follow-up of 36-150 months
    Okcu, G; Aktuglu, K
    Introduction. Complex femoral fractures pose considerable therapeutic challenges to orthopedic surgeons. We present a retrospective review of 25 patients with complex femoral fractures treated with intramedullary locked nailing and supplemental screw fixation. Materials and methods. Fifteen patients with ipsilateral femoral neck and shaft fractures (group 1) and 10 patients with ipsilateral femoral shaft and distal femur fractures (group 2) were treated from 1990 to 1998. High-energy injuries occurred in all patients. There were 4 open fractures. Antegrade, locked nailing of diaphyseal fractures was performed in all cases. Supplemental screws for the neck were used in all patients in group 1 and in 3 patients in group 2. Results. All of the fractures united during the follow-up. Five patients in group 1 underwent reoperation (33.3%): one due to a delayed union, the second due to an implant failure, the third due to a nonunion of a neck fracture, and the last two because of an initially missed femoral neck fracture. None of the patients in group 2 underwent reoperation. Angular malalignment of the shaft was found in 6 fractures in group 1 (average 4.8(o), range 3(o)-11(o)) and in 4 fractures in group 2 (average 6(o), range 3(o)-12(o)). Shortening of the limb occurred in 3 patients in group 1 (average 1.4 cm, range 1-1.8) and in 1 patient in group 2 (2 cm). Loss of fixation was seen in 1 patient in each group. Avascular necrosis and infection were not seen in any case in both groups. Conclusion. Femoral intramedullary nails with antegrade or retrograde options for insertion and different locking possibilities have extended the indications to include both diaphyseal and metaphyseal fractures. New nail designs, usually more expensive than the conventional nails, have been introduced into the market for this purpose. One has to keep in mind that antegrade, locked nailing of femoral shaft fractures combined with neck or distal femur fractures is a technically demanding but efficacious procedure. The success rate is high when the technique is meticulously implemented.
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    Intra-articular fractures of the tibial plafond - A comparision of the results using articulated and ring external fixators
    Okcu, G; Aktuglu, K
    We retrospectively reviewed 60 fractures of the tibial plafond treated by either an ankle-sparing diaphyseal-epiphyseal technique using the llizarov ring fixator or by an ankle-spanning technique using a monolateral articulated external fixator. The llizarov ring fixator was applied in 24 fractures and the monolateral articulated transarticular external fixator in 20. Both techniques were combined with limited open reduction and internal fixation of the articular surface if necessary. Between three and nine years after the injury, all patients returned for clinical and radiological assessment and evaluation of ankle function using the modified Mazur score. There were no significant differences between the two groups in terms of age, gender, mechanism of injury, type of fracture or length of follow-up. The mean functional ankle score was 86 points for the llizarov group and 82 points for the articulated fixator group. The difference was not significant (p = 0.07). There were no significant differences between the groups with regard to the radiographic score and late complications. Patients treated with the Ilizarov ring fixator had significantly better ankle and subtalar movement. We conclude that both techniques of external fixation are satisfactory methods of treatment for fractures of the tibial plafond, but that the total arc of movement of the joint is preserved better without bridging the ankle.
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    Which Implant Is Better for Treating Reverse Obliquity Fractures of the Proximal Femur: A Standard or Long Nail?
    Okcu, G; Ozkayin, N; Okta, C; Topcu, I; Aktuglu, K
    Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws. Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants. However, it is unclear whether nail length influences healing. We compared standard and long types of intramedullary hip nails in terms of (1) reoperation (fixation failure), (2) 1-year mortality rate, (3) function and mobility, and (4) union rate. We conducted a pilot prospective randomized controlled trial comparing standard versus long (a parts per thousand yen 34 cm) intramedullary hip nails for reverse obliquity fractures of the proximal femur from January 2009 to December 2009. There were 15 patients with standard nails and 18 with long nails. Mean age was 79 years (range, 67-95 years). We determined 1-year mortality rates, reoperation rates, Parker-Palmer mobility and Harris hip scores, and radiographic findings (fracture union, blade cut-out, tip-apex distance, implant failure). Minimum followup was 12 months (mean, 14 months; range, 12-20 months). We found no difference in reoperation rates between groups. Two patients (both from the long-nail group) underwent revision surgery because of implant failure in one and deep infection in the other. There was no difference between the standard- and long-nail groups in mortality rate (17% versus 18%), Parker-Palmer mobility score (five versus six), Harris hip score (74 versus 79), union rate (100% in both groups), blade cut-out (zero versus one), and tip-apex distance (22 versus 24 mm). Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either standard or long intramedullary nails.
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    Should full threaded compression screws be used in adult femoral neck fractures?
    Okcu, G; Özkayin, N; Erkan, S; Tosyali, HK; Aktuglu, K
    Introduction: Operative treatment consisting of fracture reduction and fixation, or arthroplasty to permit early patient mobilization, continues to be the treatment of choice for most femoral neck fractures. Options for internal fixation have included a variety of implants; however most recent reports and textbooks cite parallel multiple cancellous screws as the surgical technique of choice. Methods: The study was prospective, randomized and IRB approved. Inclusion criteria included skeletal maturity, closed femoral neck fracture without concomitant fractures or injuries with complete charts and adequate radiographs obtained from the initial injury till the last follow-up. Forty-four patients were enrolled in this study during one-year period at two university centers. 22 were randomized to be treated with full threaded, cannulated compression screws (Acutrak 6/7, ACUMED) (Group 1) and the other 22 with 16 mm partial threaded, 6.5 mm or 7.3 mm cannulated screws (SYNTHES) (Group 2). Three or four screws were used in both groups according to fracture type and surgeon's preference. Data evaluated included surgical time, fluoroscopy time, fracture type, radiological outcome, complications and functional status using the Harris Hip Score. Results: Both groups were comparable in terms of age and gender. There was not a significant difference in terms of surgical time, follow-up period, fracture type, or fluoroscopy time. There were eight complications in Group 1 and two in Group 2 (P = 0.049) Time to union was significantly longer in Group 1 (P = 0.001). However, Hip Scores were not significantly different in both groups (P = 0.20). Conclusion: When compared with full threaded compression screws, partial-hreaded cannulated screws provides a shorter union time and less complication rate while providing equivalent functional results in adult femoral neck fractures. (C) 2015 Elsevier Ltd. All rights reserved.
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    Surgical treatment of displaced radial neck fractures in children with Metaizeau technique
    Okçu, G; Aktuglu, K
    BACKGROUND The treatment of radial neck fractures in children is difficult when the angular displacement exceeds 30 degrees. The authors report their experience with closed reduction of this fracture and intramedullary pinning which was described and popularized by Metaizeau et al. in 1980. METHODS Under general anesthesia and guidance of an image intensifier, a I cm incision was made on the radial side of distal radial metaphysis. A Kirschner wire was contoured and then the last 3-5 mm were bent approximately 30 degrees. It was introduced into the medullary canal of the radius and by pushing it proximally until its point reaches the inferior aspect of the epiphysis to elevate and rotate to achieve an anatomic reduction. This technique was used in nine patients between 1996 and 2003. RESULTS Full functional recoveries with excellent results were observed in all cases but one at the last follow-up. No complication was encountered. CONCLUSION We recommend this closed technique as it is relatively simple and associated with encouraging results.
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