Browsing by Author "Aktuglu K."

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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
    (2003) 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°, range 3°-11°) and in 4 fractures in group 2 (average 6°, range 3°-12°). 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 (2cm). 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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    Management of shotgun-induced fractures of the humerus with Ilizarov external fixator
    (2004) Okcu G.; Aktuglu K.
    We retrospectively reviewed 11 shotgun-induced open humeral fractures treated with immediate application of Ilizarov type ring external fixation. Eight patients had grade III A and three had grade III B open fractures. No patient had associated neurovascular injury. All fractures were stabilized with Ilizarov external fixator immediately after meticulous debridement and irrigation under emergent conditions. Complete bony union occurred in all patients in 14-44 weeks (mean, 21 weeks). One patient required a second intervention to adjust the external fixator rings. Two patients required a rotational fasciocutaneous flap to handle the soft tissue coverage problem. Superficial pin tract infection was present in eight patients; however none of them had deep infection or osteomyelitis. A good to excellent result was achieved in 10 patients according to the rating system of Smith and Cooney. Immediate Ilizarov external fixation is a safe method of obtaining a functional limb in the treatment of shotgun-induced open humeral fractures with severe soft tissue damage.
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    Intra-articular fractures of the tibial plafond. A comparison of the results using articulated and ring external fixators
    (2004) Okcu G.; Aktuglu K.
    We retrospectively reviewed 60 fractures of the tibial plafond treated by either an ankle-sparing diaphyseal-epiphyseal technique using the Ilizarov ring fixator or by an ankle-spanning technique using a monolateral articulated external fixator. The Ilizarov 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 Ilizarov 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. © 2004 British Editorial Society of Bone and Joint Surgery.
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    Management of shotgun induced open fractures of the humerus with Ilizarov external fixator
    (2005) Okcu G.; Aktuglu K.
    BACKGROUND: Our aim was to evaluate the clinical efficacy of Ilizarov external fixator used for the management of shotgun induced open humeral fractures with special emphasize on neurovascular sequelae. METHODS: The authors retrospectively reviewed eleven shotgun induced open humeral fractures managed with emergent application of Ilizarov external fixator. No patient had associated neurovascular injury. All fractures were stabilized with Ilizarov external fixator immediately after meticulous debridement and irrigation under emergent conditions . RESULTS: With Ilizarov fixation technique complete bony union occurred in all patients within 14 to 44 weeks (average, 21 weeks) postoperatively.. One patient required a second intervention in order to adjust the external fixator rings. Two patients required a rotational fasciocutaneous flap so as to handle the soft tissue coverage problem. Superficial pin tract infection was present in eight patients, however in none of the patients deep tissue infection or osteomyelitis has been observed. Good to excellent results were achieved in 10 patients with Ilizarov fixation technique according to the rating system proposed by Smith and Cooney. CONCLUSION: Emergent Ilizarov external fixation is a safe method of obtaining a functional limb in the management of shotgun induced open humeral fractures with severe soft tissue damage.
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    Which implant is better for treating reverse obliquity fractures of the proximal femur: A standard or long nail?
    (Springer New York LLC, 2013) Okcu G.; Ozkayin N.; Okta C.; Topcu I.; Aktuglu K.
    Background: 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. Questions/purposes: 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. Methods: We conducted a pilot prospective randomized controlled trial comparing standard versus long (≥ 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). Results: 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). Conclusions: Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either standard or long intramedullary nails. Level of Evidence: Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.
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    Different trends in trauma care - The Turkish perspective
    (Elsevier Ltd, 2015) Aktuglu K.; Okcu G.
    [No abstract available]