Browsing by Author "Okçu, G"
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Item Surgical treatment of displaced radial neck fractures in children with metaizeau technique: Late-term results Metaizeau technique : Late term resultsTosyali, HK; Hancioglu, S; Kaya, H; Okçu, G; Aktuglu, KAim: 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.Item Soft tissue osteoma: A case reportTemiz, P; Bastürk, O; Ayhan, S; Yilmaz Ovali, G; Okçu, GSoft tissue osteomas are very rare and should be differentiate from other osseous lesions of soft tissue. We present two patients and discuss their clinical, radiologic and histopathological features with literatures. The first patient was 17-year-old boy, amateur football player. The other was a 43-year-old man had a firm, painless mass at his right knee. Their medical history had both trauma to their knees. Radiologically, heterogenous nodular calcification areas were observed near the proximal metaphysis of their tibias. Hardly lobulated lesions without bone attachment at the ligaments were excised. These lesions were gray-white coloured, well-circumscribed, firm masses. Microscopically, welldefined, lobulated lesions were involved mature lamellar bone trabeculae and enchondral ossification areas at peripherial portion. Both of our patients are survived healty for four years.Item Clinical and Radiological Outcomes of Trochanteric AO/OTA 31A2 Fractures: Comparison between Helical Blade and Lag Screw - A Retrospective Cohort StudyHancioglu, S; Gem, K; Tosyali, HK; Okçu, GIntroduction The purpose of this study was to compare the clinical and radiological outcomes of AO/OTA type 31A2 fractures treated by the use of trochanteric nails either with a blade or a screw. Patients and Methods This study was designed retrospectively. Between May 2007 and May 2014, a total of 144 patients with trochanteric fractures were admitted to the clinic, and only 65 of them met the inclusion criteria. Thirty-two of them (blade group) were treated with a helical blade and the rest of the 33 patients (screw group) were treated with a screw. The mean ages of the patients were 76.01 and 75.82, respectively (p = 0.905). The mean follow-up time was 27.6 months (blade group: 34.2 +/- 19.1 months; screw group: 18.6 +/- 7.9 months; p < 0.001). Between these two groups, we evaluated the differences in tip apex distances (TAD), calcar-referenced tip-apex distances (Cal-TAD), implant positions, cut-out rates, and implant failures. Functional outcomes were measured with the help of the Harris Hip Score. Results No significant differences were seen between the blade and screw groups by means of cutting out, implant positions, and varus collapse. Cutting out was seen in a total of six patients (blade group n = 2; screw group = 4; p = 0.672) and varus collapse in nine patients (blade group n = 5, screw group n = 4; p = 0.733). Harris Hip Scores were similar between the two groups (blade group: 72.70 +/- 18.43; screw group: 80.83 +/- 18.75; p = 0.84).Item Surgical treatment of displaced radial neck fractures in children with Metaizeau techniqueOkçu, G; Aktuglu, KBACKGROUND 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.Item The role of trigger point therapy in knee osteoarthritisYentür, EA; Okçu, G; Yegül, IBackground and objectives: The purpose of this study was to investigate whether injection of trigger points with lidocaine combined with intra-articular hyaluronic acid injection would be more effective in pain reduction and assisting daily activities of patients with knee osteoarthritis then hyaluronic acid injection alone. Methods: Thirty-four, female, osteoarthritis patients were randomly assigned into two groups (hyaluronic acid group, n = 17; trigger point group, n = 17). Patients in the trigger point group received intraarticular 2 ml Na-hyaluronate injections and trigger point injections, three times with one-week intervals. The hyaluronic acid group received only hyaluronic acid injections. Before the treatment and 7 days after the third injection, the same physician who was blind to the treatment, assessed the intensity of pain at rest or during normal daily activities, activity restrictions, and joint range of motion. Results: A significant improvement of pain and reduction of activity restrictions was observed in the trigger point group (p < 0.001) while in the hyaluronic acid group, there were significant improvements only in squatting and walking (p = 0.03). A significant improvement in range of movement was observed only in the trigger point group.Item Gastric Metastasis of Merkel Cell Carcinoma: Case ReportTemiz, P; Ayhan, S; Adigüzel, L; Kara, E; Okçu, GMerkel cell carcinoma (MCC) of skin is a rare tumor with aggressive behavior. Local recurrences, regional lymph node and distant metastases of MCC are frequent but to date metastasis to upper gastrointestinal tract was reported only a few. We present a 75-year-old man who had primary MCC at his left thigh. The tumor was excised and the patient was directed to local radiotherapy. He had developed abdominal and thoracal subcutaneous metastatic nodules within 5 and 8 months after surgical excision, respectively. In the tenth month, a second operation had to be performed because of a perforated duodenal ulcer and incidentally a submucosal yellow-white nodule measuring 2 cm in diameter was found in the wall of gastric cardia and excised. This lesion was histologically identical to the primary tumor, hence, gastric metastasis of MCC. The patient rejected further therapy and died 17 months after the initial diagnosis. Differential diagnosis of MCC and distinction of gastrointestinal MCC metastasis from primary neuroendocrine tumors may be difficult. Clinical information and histopathological features along with the results of immunohistochemical stainings are very important in this distinction.Item Evaluation of hemostatic changes using thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgeryTopçu, I; Çivi, M; Öztürk, T; Keles, GT; Çoban, S; Yentür, EA; Okçu, GThe effects of Ringer lactate, 6% hydroxyethyl starch (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% hydroxyethyl starch 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (alpha), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the alpha angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the alpha angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, alpha angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.Item Evaluation of injection techniques in the treatment of lateral epicondylitis: a prospective randomized clinical trialOkçu, G; Erkan, S; Sentürk, M; Özalp, RT; Yercan, HSObjective: We aimed to compare the efficacy of two different injection techniques of local corticosteroid and local anesthetic in the management of lateral epicondylitis. Methods: This prospective study followed 80 consecutive patients who were diagnosed with lateral epicondylitis at our hospital outpatient clinic between 2005 and 2006. Patients were randomly assigned into two equal groups. Group 1 received a single injection of 1 ml betamethasone and 1 ml prilocaine on the lateral epicondyle at the point of maximum tenderness. Group 2 patients received an injection of the same drug mixture. Following the initial injection, the needle tip was redirected and reinserted down the bone approximately 30 to 40 times without emerging from the skin, creating a hematoma. Patients were evaluated with the Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire before injection and at the final follow-up. The unpaired t-test and chi-square tests were used to compare results. Results: Sixteen patients in Group 1 and 15 patients in Group 2 were lost during follow-up. The average follow-up period of the remaining 49 patients was 21.6 months. There were no significant differences between the two groups with regard to gender, age, follow-up period, symptom duration, involvement side and number of dominant limbs. The Turkish DASH scores of Group 2 were significantly lower than those of Group 1 (p=0.017). Conclusion: Long-term clinical success in the treatment of lateral epicondylitis depends on the injection method. The peppering technique appears to be more effective than the single injection technique in the long-term.Item The treatment of Kienbock disease with vascularized bone graft from dorsal radiusÖzalp, T; Yercan, HS; Okçu, GNumerous surgical treatment options are proposed for the Kienbock disease but there has not been a consensus on the most appropriate method yet. The aim of this study is to present our experience and preliminary results of the use of vascularized bone graft from dorsal radius. Second and third intercompartmental supraretinacular artery pedicled bone graft has been used to treat 11 patients with Kienbock disease between 2001 and 2006. The average follow-up period was 37 months (range 19-77 months). Pre- and post-operative range of motion, pain and grip strength, radiologic parameters such as carpal height ratio, Stahl index and scapholunate angle were evaluated. Eleven patients were composed of two stage II, one stage IIIA and eight stage IIIB patients according to Lichtmann classification. At the end of the observation period, five excellent, four good, one fair and one poor results were observed. There were no or little changes in carpal height ratio and Stahl index. Pain has diminished considerably. We believe that the treatment of Kienbock disease with vascularized bone graft from the dorsum of the radius has encouraging results and need no other additional procedures.Item Closed reduction and casting versus Kapandji technique for the treatment of Colles fracturesVural, Ö; Okçu, G; Özalp, RT; Akkaya, MG; Yercan, HSObjectives To compare the outcome of closed reduction and cast immobilization with Kapandji method for the treatment of the Colles fractures. Patients and methods Between 2003-2006, 33 patients with 33 Colles fractures that referred and followed in the Orthopaedics and Traumatology department or emergency service were included into the study. The patients were randomly allocated into the closed reduction and cast immobilization and Kapandji method groups. Radiological and clinical results were evaluated. Nine patients were male, twenty-four were female and the mean age was 51.9 years (23-76). The mean follow up period was 14 months (6-30). Results There were 14 patients treated with the Kapandji method. The functional outcome was good or excellent in %85.7 of these patients according to the Gartland-Werley evaluation score. There were 19 patients treated with closed reduction and casting. The functional outcome was good or excellent in %94.7 of them. There were no significant difference between the two treatment groups (p=0,971). In radiological evaluation, the palmar inclination angle was found to be preserved much more better in the Kapandji group than the closed reduction and cast immobilization group (p=0,003). There were no significant difference between two groups according to the radial length (p=0,524) and radial inclination angle (p=0,594). Conclusion Closed reduction and cast immobilization is an effective treatment method in Colles fractures. In spite of the need for fluoroscopic examination, Kapandji method is an easily applicable treatment modality with very low cost and morbidity. As the functional results are similar, Kapandji method is a reliable option for older patients who refuse cast immobilization or noncompliable with casting.Item Influence of number and orientation of screws on stability in the internal fixation of unstable femoral neck fracturesGümüstas, SA; Tosun, HB; Agir, I; Orak, MM; Onay, T; Okçu, GObjective: The aim of this study was to biomechanically compare 3 different cannulated screw configurations used in internal fixation of unstable femoral neck fractures. Methods: The study included 28 synthetic left femurs randomly divided into 4 equal groups. Samples in the first 3 groups were osteotomized in the basicervical region to create Pauwels Type 3 fractures. Fixation was carried out using cannulated screws. In Group 1, four screws were used including 3 in an inverted triangle configuration in parallel with the neck and the fourth screw transversely into the calcar. In Group 2, three screws were used including 2 in parallel with the neck and the third transversely into the calcar. In Group 3, three screws were used in an inverted triangle configuration in parallel with the neck. No osteotomy or fixation was carried out in Group 4. Load test was performed on all the groups and the strength of the screw fixations against axial load and their amount of relocation were measured. Results: Average maximum strength was 36.1 +/- 3.2 N/mm(2) in Group 1, 27.3 +/- 4.1 N/mm(2) in Group 2 and 21.9 +/- 3.2 N/mm(2) in Group 3. The average relocation in the line of osteotomy in the moment of average maximum stress (21.9 +/- 3.2 N/mm(2)) was 11.5 +/- 2.1 mm in Group 3,6 +/- 1.3 mm in Group 2 and 5.8 +/- 1.1 mm in Group 1 (p<0.05). It was also observed that while the relocation in the moment of average maximum stress (27.3 +/- 4.1 N/mm(2)) was 9.1 +/- 1.7 mm in Group 2, the deformation under the same stress value was 9 +/- 1.7 mm in Group 1 (p>0.05). Conclusion: The use of a transverse screw in the calcar in addition to cannulated screws parallel to the neck appear to provide stability benefit in the treatment of unstable femoral neck fractures.Item Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: A prospective randomised clinical studyÖzkayin, N; Okçu, G; Aktuglu, KIntroduction: 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.