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Browsing by Author "Tosyali, HK"

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Clinical and radiological outcomes of chronic severe severe slipped capital epiphysis patients treated by surgical dislocation and modified Dunn osteotomy: Case series
Hancioglu, S; Tosyali, HK; Erkan, S; Yercan, HS
Objectives: This study aims to evaluate the clinical and radiological outcomes of patients with chronic severe slipped capital femoral epiphysis (SCFE) treated by surgical dislocation and modified Dunn osteotomy (MDO). Patients and methods: This retrospective study. conducted between January 2010 and December 2017. included nine patients (8 males. 1 female: mean age 12.6 years: range. 7 to 16 years) with nine hips. The degree of corrections in Southwick angle and alpha angle were measured on frog-leg views. Range of motion (ROM) of the hips was measured at each follow-up visit. Heyman and Herndon classification system and Harris Hip Score (HHS) were evaluated for clinical and functional outcomes at the latest follow-up visit. Results: The mean follow-up time was 34.8 months. Avascular necrosis complication was observed in one hip. Except two patients with lateral femoral cutaneous neuropathy, none of the patients suffered from any other complications. Mean preoperative Southwick angle of 59.1 degrees was corrected to an angle of -0.8 degrees postoperatively. Alpha angles were calculated as 44.6 degrees postoperatively. Modified Dunn osteotomy resulted in marked improvement in hip ROM in all directions and increased HHS. Conclusion: Our results encourage us to use this method in treating SCFE patients with chronic severe slips.
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.
Penumbra signin knee pain: a case of distal femur osteomyelitis
Tosyali, HK; Cakir, A
Penumbra signis a characteristic finding in magnetic resonance imaging (MRI) of Brodie's abscess, a rare variant of subacute osteomyelitis. We aimed to discuss the imaging finding penumbra sign that will help in the diagnosis of osteomyelitis and may be useful to clinicians in differential diagnosis. A 26-year-old male patient presented to the emergency department with complaints of pain and limping in the right knee that did not go away. He had a history of arthroscopic debridement and percutaneous fixation surgery dueto osteochondral fragment 3 years ago. There were no additional findings in the patient's vital parameters, physical examination, and medical history. X-ray imaging revealed two screws in the distal femur and a well-defined sclerotic rim surrounding a radiolucent lesion anterior to the screws. MRI revealed a lesion in the distal femoral metaphysis with low-density fluid and hyperintense granulation tissue surrounding it. After surgical abscess drainage and local debridement, bone cement was placed in the resulting cavity. Teicoplanin treatment was started. The patient was discharged and complete recovery was achieved in the second month. The diagnosis of osteomyelitis is often missed or confused with bone tumors in non-traumatic cases presenting with persistent bone pain. MRI imaging is frequently used in differential diagnosis, and detection of characteristic imaging signs such as the penumbra sign accelerates the diagnosis. In this context, emergency department clinicians, in particular, should be cautious and not forget that early treatment can be started by recognizing these signs.
Chronic fixed-permanent lateral patellar dislocation can be successfully corrected in skeletally mature patients, with satisfactory midterm outcomes
Teküstün, F; Tosyali, HK; Yercan, HS
BackgroundChronic permenant lateral patellar dislocation is a rare, complex condition that affects an adult's entire lower extremity and may cause functional impairment. This study aimed to identify single-stage surgery for functional recovery in patients and to assess the radiological and functional outcomes of our technique, particularly concerning patellofemoral osteoarthrosis, at mid-term follow-up.MethodsThe study retrospectively analyzed eight patients with eleven afflicted knees who had our novel surgical method, termed the all-in-one treatment, from 2011 to 2017. The average follow-up duration was 11.3 years, with a range of 6 to 12 years. An analysis was conducted on the files of patients who satisfied the specified criteria. Data, comprising questionnaires, clinical examinations, radiographs, and functional assessments, were recorded. All patients underwent assessments of the lateral patellofemoral angle, compliance angle, Iwano classification, sulcus angle, and Wiberg-Patellar type. We classified all patients according to the Outerbridge chondromalacia classification, and conducted additional clinical assessment using the Kujala et al. patellofemoral impairment score.ResultsAll patients experienced functional improvement, with a mean preoperative Kujala score of 40.89 and a mean postoperative Kujala score of 68.3. No instances of bone nonunion, skin necrosis, or periprostatic fractures were identified in our investigation. No significant degenerative alterations were observed on tomography throughout follow-up, except in one patient who had undergone trochleoplasty. During the postoperative period, no patient experienced any instability.ConclusionOur study's primary finding is that the functional gain of knees with chronic dislocations, on which we performed our surgical approach, demonstrated a significant long-term improvement. However, further research is needed to compare single-stage and multi-stage treatments and to assess the long-term outcomes of these treatments and the associated risk of patellafemoral osteoarthritis, re-dislocation, and loss of functional gain.
Clinical and Radiological Outcomes of Trochanteric AO/OTA 31A2 Fractures: Comparison between Helical Blade and Lag Screw - A Retrospective Cohort Study
Hancioglu, S; Gem, K; Tosyali, HK; Okçu, G
Introduction 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).
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.
Which implant is better for the fixation of posterior wall acetabular fractures: A conventional reconstruction plate or a brand-new calcaneal plate?
Tosyali, HK; Elibol, FKE; Hancioglu, S; Kacmaz, SE; Caliskan, ÖI; Tolunay, T; Demir, T; Oklu, G
Background: Increased posterior wall acetabular fractures among older adults, require precise treatment to restore stability to the joint, lower the risk of degenerative arthritis, and enhance overall functional recovery. The purpose of this study was to compare the fixation stability and mechanical characteristics of calcaneal buttress plate and conventional reconstruction plate under different loading condition. Methods: Typical acetabular posterior wall fractures were created on twenty synthetic hemipelvis models. They were fixed with calcaneus plate and reconstruction plate. Dynamic and static tests were performed. Displacements of fracture line and stiffness were calculated. Findings: After dynamic loading, calcaneus plate fixation has significantly less displacement than the reconstruction plate on the superior posterior wall. Under static loading condition, the calcaneus plate group has significantly less displacement than the reconstruction plate group on the inferior posterior part of the fracture. The average stiffness values of the calcaneus plate group and the reconstruction plate group were 265.16 +/- 53.98 N/mm and 167.48 +/- 36.87 N/mm, respectively and a statistically significant difference was found between the two groups. Interpretation: The calcaneal plate group demonstrated better stability along the fracture line after dynamic and static loading conditions. Especially when the fragment was on the acetabulum's superior posterior, inferior posterior, and inferior rim, Calcaneal buttress plates offer biomechanically effective choices.
Management of Chondroblastoma in Pediatric Patients: 21 Years of Single-Center Experience
Tosyali, HK; Kaya, H; Kececi, B; Sabah, D
Background: Chondroblastoma (CB), a rare benign bone tumor that produces chondrocytes, often develops in the epiphysis or apophysis of children and young adults. The treatment of these rare tumors is complex. The standard treatment protocol involves curettage with local adjuvants and bone graft or cement application. The authors examined 38 CBs to determine risk factors for local recurrence, complications, and functional outcomes following epiphyseal curettage. Methods: Twenty-two girls and sixteen boys aged 10 to 17 years with histologically confirmed chondroblastoma who arrived at our hospital between January 2000 and June 2021 were reviewed retrospectively. Clinical data, radiographic images, histological results, treatment, functional outcomes, and the local recurrence rate were examined-surgical treatment involved total tumor curettage, followed by bone grafting and adjuvant techniques. Local recurrences have also been reported. Results: The most frequently affected site was the proximal femur. Sites of involvement included the proximal femur in 10 (26.3%) cases, the proximal tibia in 8 (20.8%), the humerus in 5 cases (13.2%), the distal tibia in 4 cases (10.5%), the distal femur in 3 cases (7.9%), the supracetabular region in 3 cases (7.9%), the talus in 1 case (2.6%), the calcaneus in 1 case (2.6%), the scapula in 1 case (2.6%), the lumbar spine in 1 case (2.6%), and the iliac bone in 1 (2.6%) patient. The mean follow-up was 144.2 months (24 to 276). The local recurrence rate was 7.9%. The mean Musculoskeletal Tumor Society (MSTS) score was 28.3 points (17 to 30). The mean duration of symptoms at presentation was 5.8 (range, 1 to 28) months. Conclusion: Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. In a relatively small proportion of cases, long-term complications and recurrence can occur due to growth plate damage and late diagnosis. In patients admitted to the pediatric clinic with pain, which is often accompanied by localized edema and joint effusion, early detection via advanced radiological scans (X-ray, CT, or MRI) may prevent delays in diagnosis.
Comparison of clinical outcomes and repair integrity after arthroscopic versus mini-open rotator cuff repair: An observational study
Tosyali, HK; Kaya, H; Hancioglu, S; Tamsel, I; Orguc, S; Tekustun, F; Kayikci, K; Kucuk, L; Ozalp, T
This study aimed to evaluate the differences between mini-open (MO) and arthroscopic (ART) repair procedures for rotator cuff tendon tears in terms of clinical and radiological outcomes. This retrospective study included 59 patients, and data were collected prospectively. Patients with full-thickness rotator cuff tears were randomized to undergo MO or ART repair at 2 centers by 2 surgeons between January 2012 and December 2017. Data were collected 3 weeks before surgery and 6 and 12 months after surgery. Physical function was assessed using the American Shoulder and Elbow Surgeons index, VAS, and Constant scoring system. Radiological outcomes were assessed using the Sugaya classification, adapted for ultrasound. Changes between baseline and follow-up were compared between the 2 groups. Fifty-nine patients who underwent ART or MO rotator cuff repair were included in this study. The 2 groups had similar demographic characteristics and preoperative baseline parameters. Both the MO and ART groups showed statistically significant improvement in outcome parameters (P <= .0001); however, cuff repair integrity was significantly better in the ART group (P = .023). All other improvements in the patient-derived parameters were equivalent. None of the patients in either group required revision surgery. According to the results of our retrospective study, MO and ART rotator cuff repair are effective and viable options for surgeons to repair rotator cuff tears. There were no differences in objective and subjective outcomes between the full ART and MO techniques for rotator cuff tears. Surgeons should choose a technique with which they are more familiar.
Given the encouraging results of biomechanical studies on femoral neck fractures, are locking plates more safe?
Hancioglu, S; Gem, K; Tosyali, HK; Okcu, G
This current study compares the clinical and radiological outcomes of femoral neck fractures in young adults treated with either cannulated screws (CS) or proximal femoral locking plates (PFLP). We conducted a retrospective study in patients aged 18 to 60 years with femoral neck fractures and investigated medical records between January 2005 and December 2016. Patients were divided into two groups based on implants, screw and plate, used for fi xation assigned. In addition, two groups were compared for their complications and functional outcomes, which were assessed with Harris Hip Score (HHS) and Parker Palmer mobility scores. Sixty-nine of 104 patients met the inclusion criteria. Forty patients were treated with cannulated screws, while 29 were treated with a proximal femoral locking plate. The two groups were comparable in terms of their perioperative variables. The overall complication rate (screw group, n = 10; plate group, n = 14) and non-union rate were significantly high in the plate group (p < 0.05). Other complications did not show statistically significant differences. The screw group had better functional outcomes than the plate group, where only the Parker-Palmer mobility score comparison was significant (p < 0.05). Poor reduction quality and Pauwels'type III fractures were statistically associated with high complication rates regardless of the implants used (p < 0.05). Although PFLP showed better outcomes in biomechanical studies than CSs, we observed poorer clinical results. Therefore, although some of our results appeared to be statistically significant, reduction quality should also be considered.
Oxytocin mitigates peripheral nerve damage via Nrf2 and irisin pathway
Tosyali, HK; Bora, ES; Cinaroglu, OS; Erbas, O
OBJECTIVE: Peripheral nerve injuries present challenges in achieving full functional restoration, necessitating effective therapeutic strategies. Oxytocin, known for its neuroprotective and anti-inflammatory properties, has shown potential in nerve recovery. This study aims to elucidate the role of oxytocin in nerve recovery via the nuclear factor erythroid 2-related factor 2 (Nrf2) and irisin pathways. MATERIALS AND METHODS: Adult male Wistar rats (n=30) were subjected to surgical dissection of sciatic nerves and divided into Control, Surgery and Saline Group, and Surgery and Oxytocin (OT) group. Electromyographic (EMG) recordings, inclined plane tests, and histological assessments were conducted to evaluate nerve function, and Nerve growth factor (NGF) immuno expression and axonal parameters were measured. Plasma irisin levels, nerve NGF, and Nrf2 levels were quantified. RESULTS: The Surgery and Saline Group exhibited impaired EMG latency, amplitude, and inclined plane score compared to Controls, while the Surgery and OT Group demonstrated improved outcomes. Histomorphometric analysis revealed increased NGF immunoexpression, axon number, diameter, and reduced fibrosis in the Surgery and OT Group. Plasma irisin levels were higher following oxytocin administration. Additionally, nerve NGF and Nrf2 levels were elevated in the Surgery and OT Group. CONCLUSIONS: OT administration mitigated nerve injury effects, promoting functional and histological improvements. Elevated NGF and Nrf2 levels, along with increased irisin, indicated the potential interplay of these pathways in enhancing nerve recovery. The results align with OT's neuroprotective and anti-inflammatory roles, suggesting its potential as a therapeutic intervention for nerve injuries. OT's positive impact on nerve recovery is associated with its modulation of Nrf2 and irisin pathways, which collectively enhance antioxidant defense and neurotrophic support and mitigate inflammation. These findings underline OT's potential as a therapeutic agent to enhance nerve regeneration and recovery. Further research is needed to elucidate the intricate molecular mechanisms and potential clinical applications of OT in nerve injury management.
Composite Reconstruction With Irradiated Autograft Plus Total Hip Replacement After Type II Pelvic Resections for Tumors Is Feasible but Fraught With Complications
Vahabi, A; Kaya, H; Tosyali, HK; Keçeci, B; Sabah, D
BackgroundMalignancies involving the pelvic ring present numerous challenges, especially in the periacetabular area. Extensive resection of the pelvic region without reconstruction can lead to severe functional impairment. Numerous reconstructive options exist, but all have drawbacks. Extracorporeally irradiated autografts are one option for reconstruction after periacetabular resections; they offer the potential advantages of eliminating the risk of allogeneic reactions associated with allografts and preserving local anatomy. However, little is known about the durability and risks of this approach in pelvic reconstruction.Questions/purposes(1) What are the survival rates of the autograft used, and if there is graft loss, what is the extent of this loss? (2) What are the functional outcomes after the implementation of this method? (3) What is the rate and nature of complications associated with this approach?MethodsThis is a retrospective case series from one subspecialty tumor unit that evaluated patients treated between January 2005 to January 2022. During that time, three surgeons treated 48 patients with Type II resections (defined as resection of periacetabular area). Patients treated with isolated Type II resections were eligible, as were those treated either with Type I+II resections, Type II+III resections, Type I+II+III resections, and Type I+II+III+IV resections. Of those, 21% (10 of 48) were treated primarily with a cone prosthesis, 13% (6 of 48) were treated without femoral reconstruction, 10% (5 of 48) were treated with resection without reconstruction, and 6% (3 of 48) had a THA on the sacrum, leaving 50% (24 of 48) of patients who were treated with femoral and acetabular reconstruction using extracorporeally irradiated autograft and total hip replacement; those patients were potentially eligible for this study. During that time span, we used this approach in all Type II pelvic resection procedures, when a part of the hemipelvis could be preserved without resection (other than Type I+II+III+IV) and where we predicted that there would be sufficient bone stock after tumor removal. Of those, 21% (5 of 24) were lost to follow-up before 2 years, and 13% (3 of 24) died within 2 years with the reconstruction intact and without any reoperation or graft loss, leaving 67% (16 of 24) for analysis here. Demographic characteristics, type of tumor, tumor origin site, type of applied resection, and extent of applied surgical procedure were noted. Of 16 patients, 12 were male, with a mean age of 38 +/- 21 years. Tumor types included chondrosarcoma in eight patients, malignant mesenchymal tumor in four patients, osteosarcoma in two patients, and Ewing sarcoma in two patients. Among these, 10 patients had tumors originating from the pelvis, whereas six patients had tumors originating from the proximal femur. We used a Kaplan-Meier estimator to calculate survivorship free from total or partial graft removal at 72 months. To measure functional results, the Musculoskeletal Tumor Society (MSTS) scoring system was utilized at most recent follow-up so as to be able to evaluate the impact of complications (if any) on the ultimate result. The MSTS score ranges from a minimum of 0 points to a maximum of 30 points, where a higher score reflects lower pain and higher functional and emotional capacity. Related complications, time of complications, secondary interventions, and mortality rates were also ascertained from chart review. ResultsGraft survival rate at 72 months after initial reconstruction, free from partial or total graft removal, was 50% (95% CI 26% to 75%). Kaplan-Meier analyses revealed estimated mean time of graft removal as 43 months (95% CI 28 to 58). The graft was protected in eight patients on their final follow-up radiographs. The median (range) MSTS score was 18 (6 to 25) of 30 points at most-recent follow-up (these scores include patients who have had their grafts removed). In all, 15 of 16 patients had 17 complications; 16 were major complications (defined as those substantial enough to result in further surgery or a life- or limb-threatening event). A total of 14 of those 15 patients underwent one or more secondary procedures (a total of 21 unplanned additional procedures were performed in those patients). Deep infection was the most common complication, occurring in eight patients. Prosthesis dislocation occurred in four patients. Three patients developed aseptic acetabular component loosening, two had graft fractures, and one patient developed heterotopic ossification.ConclusionComposite reconstruction with extracorporeal irradiated autografts plus total hip replacement is a feasible reconstruction technique after Type II pelvic resections, although complications and reoperations were common. Although no reconstruction technique has been proven superior to other alternatives, the high risk of complications and reoperations associated with this technique should be considered when selecting from among possible alternative reconstruction methods.Level of EvidenceLevel IV, therapeutic study.

Browsing by Author "Tosyali, HK"

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